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Epidemiology/Health Services/Psychosocial Research

Relationship of Depression and Diabetes Self-Care, Medication Adherence, and Preventive Care

  1. Elizabeth H.B. Lin, MD, MPH1,
  2. Wayne Katon, MD2,
  3. Michael Von Korff, SCD1,
  4. Carolyn Rutter, PHD1,
  5. Greg E. Simon, MD, MPH1,
  6. Malia Oliver, BA1,
  7. Paul Ciechanowski, MD, MPH2,
  8. Evette J. Ludman, PHD1,
  9. Terry Bush, PHD1 and
  10. Bessie Young, MD3
  1. 1Center for Health Studies, Group Health Cooperative, Seattle, Washington
  2. 2Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington
  3. 3Department of Medicine, Veterans Administration Hospital, University of Washington, Seattle, Washington
  1. Address correspondence and reprint requests to Elizabeth H.B. Lin, MD, MPH, Center for Health Studies, Group Health Cooperative, 1730 Minor Ave., Suite 1600, Seattle, WA 98101. E-mail: lin.e{at}ghc.org
Diabetes Care 2004 Sep; 27(9): 2154-2160. https://doi.org/10.2337/diacare.27.9.2154
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Article Figures & Tables

Tables

  • Table 1—

    Clinical characteristics

    Clinical characteristicsnMeans ± SD or percent
    Type 2 diabetes95.6
    Treatment intensity
        Diet25.4
        Oral hypoglycemic59.0
        Insulin, alone, or plus oral medications30.1
        Number of HbA1c tests in prior year2.2 ± 1.3
        HbA1c level (%)7.8 ± 1.6
        Number of diabetes complications1.4 ± 1.5
        Major depression12.0
        BMI >30 kg/m248.9
        Smoker8.7
    General self-care activities (days performed in the past week)4,463
        Healthy eating once weekly or less9.8
        Five servings of fruits/vegetables once weekly or less21.6
        High-fat foods ≥6 days12.4
        Physical activity once weekly or less (≥30 min)29.3
        Specific exercise session once weekly or less47.8
    Diabetes-specific self-care (patients on hypoglycemic medications or insulin)3,439
        Tested blood sugar once weekly or less17.9
        Tested recommended times once weekly or less24.8
        Checked feet once weekly or less20.1
        Checked inside of shoes once weekly or less59.9
    Medication adherence2,655
        Nonadherence to oral hypoglycemic medicines in prior year19.5 (64.7 days)
  • Table 2—

    Diabetes self-care and depression*

    Self-care activities (past 7 days)nNo major depressionMajor depressionOdds ratio†95% CIP
    Diet
        Healthy eating once weekly or less8.8%17.2%2.11.59–2.72<0.0001
        Five servings of fruits/vegetables once weekly or less21.1%32.4%1.81.43–2.17<0.0001
        High-fat foods ≥6 times weekly11.9%15.5%1.31.01–1.73<0.04
    Exercise
        Physical activity (≥30 min) once weekly or less27.3%44.1%1.91.53–2.27<0.0001
        Specific exercise session once weekly or less45.8%62.1%1.71.43–2.12<0.0001
    Smoking
        Yes7.7%16.1%1.91.42–2.51<0.0001
    Glucose monitoring (patients on medications)3,439
        Test blood glucose less than once weekly17.8%18.2%1.10.80–1.44NS
        Test blood glucose as recommended less than once weekly24.5%26.7%1.10.89–1.47NS
    Foot check (patients on medications)3,439
        Checked feet less than once weekly20.1%19.7%1.00.76–1.29NS
        Checked inside of shoes less than once weekly59.7%61.4%1.10.88–1.36NS
    Total3,927536
    • *

      ↵* Percentages are unadjusted;

    • †

      ↵† Odds ratios are adjusted for the covariates age, sex, marital status, education, race/ethnicity, medication risk, complications, treatment intensity, clinic, and physician generalized estimating equation (GEE).

  • Table 3—

    Medication adherence and use of preventive diabetes services*

    Unadjusted means/proportions
    Model-based (adjusted) estimates
    No major depressionMajor depressionMean differenceOdds ratio95% CIP (n)
    Nonadherence to medication
        Oral hypoglycemic18.8%24.5%3.62—1.18–6.06<0.005
        Lipid lowering19.3%27.2%6.79—3.11–10.46<0.0005
        ACE inhibitors21.6%27.9%5.59—1.41–9.780.01
    Preventive diabetes services
        No HbA1c test within the last year4.0%6.3%—1.91.27–2.87<0.005 (4,347)
        Fewer than three HbA1c tests per year among patients with HbA1c >8%55.1%55.5%—0.90.70–1.21NS (1,922)
        No retinal examination within the last year19.4%17.2%—1.00.74–1.24NS (4,347)
        Less than two examinations within 2 years among patients with retinopathy24.8%22.5%—0.80.55, 1.31NS (1,179)
        No microalbumin urine test within the last year among patients not taking ACE inhibitors47.0%45.6%—1.00.80–1.33NS (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.

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Diabetes Care: 27 (9)

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September 2004, 27(9)
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Relationship of Depression and Diabetes Self-Care, Medication Adherence, and Preventive Care
Elizabeth H.B. Lin, Wayne Katon, Michael Von Korff, Carolyn Rutter, Greg E. Simon, Malia Oliver, Paul Ciechanowski, Evette J. Ludman, Terry Bush, Bessie Young
Diabetes Care Sep 2004, 27 (9) 2154-2160; DOI: 10.2337/diacare.27.9.2154

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Relationship of Depression and Diabetes Self-Care, Medication Adherence, and Preventive Care
Elizabeth H.B. Lin, Wayne Katon, Michael Von Korff, Carolyn Rutter, Greg E. Simon, Malia Oliver, Paul Ciechanowski, Evette J. Ludman, Terry Bush, Bessie Young
Diabetes Care Sep 2004, 27 (9) 2154-2160; DOI: 10.2337/diacare.27.9.2154
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