Abstract

Objective: to determine whether pharmacologic treatment of depression in low income minorities with diabetes improves A1C and quality of life (QOL).

Research Design and Methods: This was a six month, randomized, double blind, placebo controlled trial. Patients were screened for depression using Whooley's two question tool at a county diabetes clinic. Depression was confirmed (or not) with the Diagnostic Interview Survey (CDIS) software program and the severity of depression assessed monthly by the Hamilton Depression Scale (HAM-D). Depressed subjects with A1C levels ≥8.0% were randomized to receive either sertraline or placebo. Diabetes care was provided by nurses following detailed treatment algorithms who were unaware of therapy for depression.

Results: 150 subjects answered positively to at least one question on the Whooley's questionnaire. The positive predictive value for depression diagnosed by CDIS was 69%, 67% and 84% for positive answers to question # 1 only, #2 only or both, respectively. Eighty-nine subjects entered the study, 75 of whom completed. An intention to treat analysis revealed significant differences between baseline and six months in HAM-D and pain scores, QOL and A1C and systolic blood pressure levels in both groups with no differences between groups for the first three but a significantly greater decrease with sertraline in A1C and systolic blood pressure levels. Changes in HAM-D scores and A1C levels were significantly correlated in all subjects (P = 0.45 (P <10⁻⁶).

Conclusion: In this low income minority population, pharmacological treatment of depression significantly improved A1C and systolic BP levels compared to placebo.