Objective To test cognitive behavioral therapy for adherence and depression (CBT-AD) in type-2 diabetes. We hypothesized that CBT-AD would improve adherence, depression, and, secondarily, hemoglobin A1c (A1C).
Research Design and Methods 87 adults with unipolar depression and uncontrolled type-2 diabetes received Enhanced Treatment As Usual (ETAU) including medication adherence-, self-monitoring of blood glucose (SMBG)-, and lifestyle-counseling; a provider letter documented psychiatric diagnoses. Those randomized to the intervention arm additionally received 9-11 sessions of CBT-AD.
Results Immediately after acute treatment (4-months), adjusting for baseline, CBT-AD had 20.7 percentage points greater oral medication adherence on electronic pill cap (95% CI: -31.14, -10.22, =.000); 30.2 percentage points greater SMBG adherence via glucometer downloads (95% CI: -42.95, -17.37, p=.000); 6.44 points lower depression scores on the Montgomery-Asberg Depression Rating Scale (95% CI: 2.33, 10.56, p=.002); .74 points lower on the Clinical Global Impression (95% CI: .16, 1.32, p=.01); and .72 units lower A1C (95% CI: .29, 1.15, p=.001) relative to ETAU. Analyses of 4-, 8- and 12-month follow-up time-points indicated that CBT-AD maintained 24.3 percentage points higher medication adherence (95% CI: -38.2, -10.3, p=.001); 16.9 percentage points greater SMBG adherence (95% CI: -33.3, -.5, p=.043); and .63 units lower A1C (95% CI: .06, 1.2, p=.03) after acute treatment ended. For depression, there was some evidence of continued improvement post-treatment, but no between-groups difference.
Conclusions CBT-AD is an effective intervention for adherence, depression, and glycemic control, with enduring and clinically meaningful benefits for diabetes self-management and glycemic control, in adults with type-2 diabetes and depression.
- Received April 5, 2013.
- Accepted October 20, 2013.
- © 2013 by the American Diabetes Association.
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