Web-Based Depression Treatment for Type 1 and Type 2 Diabetic Patients

A randomized, controlled trial

  1. Frank J. Snoek, PHD1,2
  1. 1Department of Medical Psychology, VU University Medical Center, Amsterdam, the Netherlands
  2. 2Institute for Health and Care Research (EMGO Institute), VU University Medical Center, Amsterdam, the Netherlands
  3. 3Department of Medical Psychology & Neuropsychology, Center of Research on Psychology in Somatic diseases (CoRPS), Tilburg University, Tilburg, the Netherlands
  4. 4Department of Clinical Psychology, VU University, Amsterdam, the Netherlands
  5. 5Netherlands Institute of Mental Health and Addiction (Trimbos), Utrecht, the Netherlands.
  1. Corresponding author: Kim M.P. van Bastelaar, k.vanbastelaar{at}


OBJECTIVE Comorbid depression is common in patients with type 1 and type 2 diabetes, adversely affecting quality of life, diabetes outcomes, and mortality. Depression can be effectively treated with cognitive behavior therapy (CBT). The Internet is a new and attractive method for delivering CBT intervention on a large scale at relatively low costs. This study evaluated the effectiveness of Web-based CBT for depression treatment in adults with type 1 or type 2 diabetes, with minimal guidance.

RESEARCH DESIGN AND METHODS A randomized controlled trial was conducted in the Netherlands in 255 adult diabetic patients with elevated depressive symptoms. Primary outcomes were depressive symptoms. Secondary outcomes were diabetes-specific emotional distress and glycemic control. Assessments were at baseline, after treatment, and at the 1-month follow-up.

RESULTS The Web-based CBT was effective in reducing depressive symptoms by intention-to-treat analyses (P = 0.04, d = 0.29; clinical improvement 41% vs. 24% P < 0.001) and by per-protocol analyses (P < 0.001, d = 0.70; clinical improvement, 56% vs. 24% P < 0.001). The intervention reduced diabetes-specific emotional distress (P = 0.03) but had no beneficial effect on glycemic control (P > 0.05).

CONCLUSIONS Web-based CBT depression treatment is effective in reducing depressive symptoms in adults with type 1 and type 2 diabetes. In addition, the intervention reduces diabetes-specific emotional distress in depressed patients.

  • Received July 1, 2010.
  • Accepted October 22, 2010.

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