PT  - JOURNAL ARTICLE
AU  - Safren, Steven A.
AU  - Gonzalez, Jeffrey S.
AU  - Wexler, Deborah J.
AU  - Psaros, Christina
AU  - Delahanty, Linda M.
AU  - Blashill, Aaron J.
AU  - Margolina, Aleksandra I.
AU  - Cagliero, Enrico
TI  - A Randomized Controlled Trial of Cognitive Behavioral Therapy for Adherence and Depression (CBT-AD) in Patients With Uncontrolled Type 2 Diabetes
AID  - 10.2337/dc13-0816
DP  - 2014 Mar 01
TA  - Diabetes Care
PG  - 625--633
VI  - 37
IP  - 3
4099  - http://care.diabetesjournals.org/content/37/3/625.short
4100  - http://care.diabetesjournals.org/content/37/3/625.full
SO  - Diabetes Care2014 Mar 01; 37
AB  - 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 Eighty-seven 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 also 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 to −10.22, P = 0.000); 30.2 percentage points greater SMBG adherence through glucometer downloads (95% CI −42.95 to −17.37, P = 0.000); 6.44 points lower depression scores on the Montgomery-Asberg Depression Rating Scale (95% CI 2.33–10.56, P = 0.002); 0.74 points lower on the Clinical Global Impression (95% CI 0.16–1.32, P = 0.01); and 0.72 units lower A1C (95% CI 0.29–1.15, P = 0.001) relative to ETAU. Analyses of 4-, 8-, and 12-month follow-up time points indicated that CBT-AD maintained 16.3 percentage points higher medication adherence (95% CI −26.1 to −6.5, P = 0.001); 22.3 percentage points greater SMBG adherence (95% CI −36.1 to −8.6, P = 0.002); and 0.63 units lower A1C (95% CI 0.06–1.2, P = 0.03) after acute treatment ended. For depression, there was some evidence of continued improvement posttreatment, but no between-group differences.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.