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.