PT - JOURNAL ARTICLE AU - Lin, Elizabeth H.B. AU - Katon, Wayne AU - Von Korff, Michael AU - Rutter, Carolyn AU - Simon, Greg E. AU - Oliver, Malia AU - Ciechanowski, Paul AU - Ludman, Evette J. AU - Bush, Terry AU - Young, Bessie TI - Relationship of Depression and Diabetes Self-Care, Medication Adherence, and Preventive Care AID - 10.2337/diacare.27.9.2154 DP - 2004 Sep 01 TA - Diabetes Care PG - 2154--2160 VI - 27 IP - 9 4099 - http://care.diabetesjournals.org/content/27/9/2154.short 4100 - http://care.diabetesjournals.org/content/27/9/2154.full SO - Diabetes Care2004 Sep 01; 27 AB - OBJECTIVE—We assessed whether diabetes self-care, medication adherence, and use of preventive services were associated with depressive illness.RESEARCH DESIGN AND METHODS—In a large health maintenance organization, 4,463 patients with diabetes completed a questionnaire assessing self-care, diabetes monitoring, and depression. Automated diagnostic, laboratory, and pharmacy data were used to assess glycemic control, medication adherence, and preventive services.RESULTS—This predominantly type 2 diabetic population had a mean HbA1c level of 7.8 ± 1.6%. Three-quarters of the patients received hypoglycemic agents (oral or insulin) and reported at least weekly self-monitoring of glucose and foot checks. The mean number of HbA1c tests was 2.2 ± 1.3 per year and was only slightly higher among patients with poorly controlled diabetes. Almost one-half (48.9%) had a BMI >30 kg/m2, and 47.8% of patients exercised once a week or less. Pharmacy refill data showed a 19.5% nonadherence rate to oral hypoglycemic medicines (mean 67.4 ± 74.1 days) in the prior year. Major depression was associated with less physical activity, unhealthy diet, and lower adherence to oral hypoglycemic, antihypertensive, and lipid-lowering medications. In contrast, preventive care of diabetes, including home-glucose tests, foot checks, screening for microalbuminuria, and retinopathy was similar among depressed and nondepressed patients.CONCLUSIONS—In a primary care population, diabetes self-care was suboptimal across a continuum from home-based activities, such as healthy eating, exercise, and medication adherence, to use of preventive care. Major depression was mainly associated with patient-initiated behaviors that are difficult to maintain (e.g., exercise, diet, medication adherence) but not with preventive services for diabetes.