Relationship of Depression and Diabetes Self-Care, Medication Adherence, and Preventive Care
Article Figures & Tables
Tables
- Table 1—
Clinical characteristics
Clinical characteristics n Means ± SD or percent Type 2 diabetes 95.6 Treatment intensity Diet 25.4 Oral hypoglycemic 59.0 Insulin, alone, or plus oral medications 30.1 Number of HbA1c tests in prior year 2.2 ± 1.3 HbA1c level (%) 7.8 ± 1.6 Number of diabetes complications 1.4 ± 1.5 Major depression 12.0 BMI >30 kg/m2 48.9 Smoker 8.7 General self-care activities (days performed in the past week) 4,463 Healthy eating once weekly or less 9.8 Five servings of fruits/vegetables once weekly or less 21.6 High-fat foods ≥6 days 12.4 Physical activity once weekly or less (≥30 min) 29.3 Specific exercise session once weekly or less 47.8 Diabetes-specific self-care (patients on hypoglycemic medications or insulin) 3,439 Tested blood sugar once weekly or less 17.9 Tested recommended times once weekly or less 24.8 Checked feet once weekly or less 20.1 Checked inside of shoes once weekly or less 59.9 Medication adherence 2,655 Nonadherence to oral hypoglycemic medicines in prior year 19.5 (64.7 days) - Table 2—
Diabetes self-care and depression*
Self-care activities (past 7 days) n No major depression Major depression Odds ratio† 95% CI P Diet Healthy eating once weekly or less 8.8% 17.2% 2.1 1.59–2.72 <0.0001 Five servings of fruits/vegetables once weekly or less 21.1% 32.4% 1.8 1.43–2.17 <0.0001 High-fat foods ≥6 times weekly 11.9% 15.5% 1.3 1.01–1.73 <0.04 Exercise Physical activity (≥30 min) once weekly or less 27.3% 44.1% 1.9 1.53–2.27 <0.0001 Specific exercise session once weekly or less 45.8% 62.1% 1.7 1.43–2.12 <0.0001 Smoking Yes 7.7% 16.1% 1.9 1.42–2.51 <0.0001 Glucose monitoring (patients on medications) 3,439 Test blood glucose less than once weekly 17.8% 18.2% 1.1 0.80–1.44 NS Test blood glucose as recommended less than once weekly 24.5% 26.7% 1.1 0.89–1.47 NS Foot check (patients on medications) 3,439 Checked feet less than once weekly 20.1% 19.7% 1.0 0.76–1.29 NS Checked inside of shoes less than once weekly 59.7% 61.4% 1.1 0.88–1.36 NS Total 3,927 536 - Table 3—
Medication adherence and use of preventive diabetes services*
Unadjusted means/proportions Model-based (adjusted) estimates No major depression Major depression Mean difference Odds ratio 95% CI P (n) Nonadherence to medication Oral hypoglycemic 18.8% 24.5% 3.62 — 1.18–6.06 <0.005 Lipid lowering 19.3% 27.2% 6.79 — 3.11–10.46 <0.0005 ACE inhibitors 21.6% 27.9% 5.59 — 1.41–9.78 0.01 Preventive diabetes services No HbA1c test within the last year 4.0% 6.3% — 1.9 1.27–2.87 <0.005 (4,347) Fewer than three HbA1c tests per year among patients with HbA1c >8% 55.1% 55.5% — 0.9 0.70–1.21 NS (1,922) No retinal examination within the last year 19.4% 17.2% — 1.0 0.74–1.24 NS (4,347) Less than two examinations within 2 years among patients with retinopathy 24.8% 22.5% — 0.8 0.55, 1.31 NS (1,179) No microalbumin urine test within the last year among patients not taking ACE inhibitors 47.0% 45.6% — 1.0 0.80–1.33 NS (1,831) - *
↵* Nonadherence to medication outcomes are continuous measures of the percentage of nonadherent days for each individual. Preventive diabetes services outcomes are dichotomous, indicating use or no use. Model-based estimates of percentage point difference in adherence and odds ratios with corresponding CIs and P values are adjusted for age, sex, marital status, education, race/ethnicity, medication risk (a pharmacy-based comorbidity measure), diabetes complications, and treatment intensity. Models also adjust for clustering by clinic and physician.
- *