DIABETES DISTRESS AND NOT CLINICAL DEPRESSION OR DEPRESSIVE SYMPTOMS IS ASSOCIATED WITH GLYCEMIC CONTROL IN BOTH CROSS-SECTIONAL AND LONGITUDINAL ANALYSES

  1. Lawrence Fisher, PhD. (fisherl{at}fcm.ucsf.edu)1,
  2. Joseph T. Mullan, PhD.2,
  3. Patricia Arean, PhD.3,
  4. Russell E. Glasgow, PhD.4,
  5. Danielle Hessler, PhD.1 and
  6. Umesh Masharani, M.D.5
  1. From the 1Department of Family & Community Medicine, University of California, San Francisco, San Francisco, California
  2. the2Department of Social & Behavioral Sciences, School of Nursing, University of California, San Francisco, San Francisco, California
  3. the 3Department of Psychiatry, University of California, San Francisco, San Francisco, California
  4. the 4Kaiser Permanente, Colorado, Denver, Colorado
  5. the 5Department of Medicine, University of California, San Francisco, San Francisco, California

    Abstract

    Objective - To determine the concurrent, prospective and time concordant relationships between major depressive disorder (MDD), depressive symptoms (DS), and diabetes distress (DD) with glycemic control.

    Research design and methods – In a non-interventional study, we assessed 506 type 2 patients for MDD (Composite International Diagnostic Interview), for DS (Center for Epidemiological Studies-Depression) and for DD (Diabetes Distress Scale), along with self-management, stress, demographics, and diabetes status, at baseline, 9 and 18 months later. Using multilevel modeling (MLM), we explored the cross-sectional relationships of the three affective variables with HbA1C; the prospective relationships of baseline variables with change in HbA1C over time; and the time-concordant relationships with HbA1C.

    Results - All three affective variables were moderately inter-correlated, although the relationship between DS and DD was higher than either was with MDD. In the cross-sectional MLM, only DD and not MDD or DS was significantly associated with HbA1C. None of the three affective variables were linked with HbA1C in prospective analyses. Only DD displayed significant time-concordant relationships with HbA1C.

    Conclusions – We found no concurrent or longitudinal association between MDD or DS with HbA1C, whereas both concurrent and time-concordant relationships were found between DD and HbA1C. What has been called “depression” among type 2 patients may really be two conditions – MDD and DD – with only the latter displaying significant associations with HbA1C. Ongoing evaluation of both DD and MDD may be helpful in clinical settings.

    Footnotes

      • Received July 7, 2009.
      • Accepted October 5, 2009.

    This Article

    1. Published online before print October 16, 2009, doi: 10.2337/dc09-1238
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