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Treating depression improves glycemic control in type 2 diabetes
Among patients with comorbid type 2 diabetes and depression, improved glycemic control was associated with antidepressant medication use, according to study findings.
“In a general practice setting, two of every three patients are not able to maintain the level of glycemic control recommended by the American Diabetes Association (HbA1c < 7%), even with intensive treatment and systematic follow-up,” the researchers wrote. “Accordingly, the [ADA] in its clinical practice guidelines invites use of complementary treatments, including depression treatment and stress reduction, that support good glycemic control.”
Jay A. Brieler, MD, of Saint Louis University School of Medicine, evaluated electronic medical record registry data of ambulatory primary care visits from 2008 to 2013 on 1,399 adults (mean age, 61.6 years) with type 2 diabetes, with depression (n = 265) and without depression (n = 1,134), to determine the effect of antidepressant medication on glycemic control. Forty patients with depression were untreated, and 225 received antidepressant medication.
Jay A. Brieler
Fifty-one percent of patients with diabetes who were treated had controlled HbA1c values compared with 42.7% of those without depression and 34.6% of those with depression who were not treated.
Compared with patients with untreated depression, those treated were twice as likely to have controlled HbA1c (OR = 1.95; 95% CI, 1.02-3.71). Glycemic control was more likely among patients without depression compared with those with untreated depression (OR = 1.37; 95% CI, 0.74-2.54).
Anxiety disorder (OR = 2.12; 95% CI, 1.31-3.45) and age (OR = 1.01; 95% CI, 1-1.02) were positively associated with glycemic control. Prescription of insulin (OR = 0.17; 95% CI, 0.28-0.49) and prescription of any other diabetes medication (OR = 0.37; 95% CI, 0.28-0.49) were negatively associated with HbA1c control.
“Our data indicate that pharmacotherapy for depression in type 2 diabetes is associated with better glycemic control. ... This study suggests that the investment of resources in research utilizing this clinical epidemiologic approach is warranted, perhaps for analyses of larger and independent data sets. Finally, our results support the emphasis on recognition and treatment of depression in diabetes by clinicians in the primary care setting.” – by Amber Cox
Disclosure: The researchers report no relevant financial disclosures.
Perspective
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Brieler and colleages investigated the use of antidepressant medication and its effect on the glycemic control of depressed patients with type 2 diabetes utilizing a retrospective cohort design. Their data indicated that pharmacotherapy for depression in patients with type 2 diabetes is associated with better glycemic control.
While the results are admirable, what happens when the antidepressant treatment is discontinued? Most antidepressants have little impact on the course of depression once discontinued, and relapse following successful treatment is common (Rubin RR, et al. Curr Diabetes Rep. 2004;4:119-125). Providing psychotropic medication(s) to treat depression, while successful, ignores the emotional issues that may also be affecting the patient. Although the subjects were considered to have a diagnosis of depression based on their ICD codes, it is unclear whether the diagnosis was based on diabetes-related distress or not related to their diabetes.
Management of depression in diabetes should be approached in a comprehensive manner, which potentially includes both medication and referral for psychotherapy, such as cognitive behavior therapy. With cognitive behavior therapy, a patient with diabetes-related distress can be taught to challenge maladaptive thoughts and behaviors that impair glycemic control and learn to better manage diabetes self-care with rational thinking and actions. When the antidepressant medication is discontinued, the improved diabetes management skills can reduce the likelihood of a relapse of depression.
Further clinical research should focus on the effectiveness of combining psychotherapy and psychopharmacology in the treatment of depressed patients with diabetes and the positive effect on mood and glycemic control.