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Counseling, exercise combination effective for improving depressive symptoms, HbA1c
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SAN DIEGO — Adults assigned to counseling alone, exercise alone or a combination of both demonstrated improvements in depressive symptoms and diabetes-related distress, according to data from the Program ACTIVE trial.
“We have learned that depression is two times more likely in people with diabetes than in the general population, and that one in four people with diabetes will have depression or clinically relevant depressive symptoms at some point in their lifetime,” Mary de Groot, PhD, associate professor of medicine and acting director of the Diabetes Translational Research Center at Indiana University, said during a press conference. “When diabetes and depression go hand in hand, as the comorbidity suggests, the impact is significant. It results in worsened blood glucose management, worsened diabetes complications across the full range of diabetes complications, greater difficulty adhering to rigors that are involved in managing diabetes on a day-to-day basis, increased medical costs, increased functional disability to perform in roles at work, home, school or family, and ultimately, premature mortality.”
De Groot and colleagues evaluated data from the Program ACTIVE II trial on 140 adults (mean age, 56 years; 74% women; 62% white) with type 2 diabetes (mean diabetes duration, 11 years) to determine the effect of a diabetes-tailored counseling intervention using cognitive-behavioral therapy and community-based exercise on depression and glycemic outcomes.
Participants were randomly assigned to cognitive-behavioral therapy for 10 sessions (n = 36), community-based exercise for 12 weeks (n = 34), cognitive-behavioral therapy plus community-based exercise concurrently for 12 weeks (n = 34; combination group) or usual care (n = 36). The usual care group received the care that they normally would from their primary care provider.
Compared with the usual care group, the other three groups reported fewer depressive symptoms (P < .05 for all), reduction in negative automatic thoughts (P < .03 for all), improved physical quality of life (P < .03 for all except cognitive-behavioral therapy only) and decreased diabetes distress (P < .01 for all). Diabetes-specific quality of life was improved in the community-based exercise group and combination group compared with the usual care group.
The odds of partial or full remission from major depressive disorder were five to six times greater in the exercise only, cognitive-behavioral therapy only and combination intervention groups compared with the usual care group (P < .03 for both), after controlling for change in antidepressant medications.
The combination intervention resulted in a clinically meaningful 0.7% improvement in HbA1c compared with participants receiving cognitive-behavioral therapy only or usual care (P < .04) in participants with a baseline HbA1c of at least 7% after controlling for baseline education levels and changes in diabetes medications.
“This is the first community-based study to show improvements in both depression and blood sugar management that combined both therapy counseling and exercise,” de Groot said. “The study also demonstrates that we have the capacity to extend access to depression care to people with type 2 diabetes in both rural and urban areas.” – by Amber Cox
Reference:
de Groot M, et al. 376-OR. Presented at: American Diabetes Association 77th Scientific Sessions; June 9-13, 2017; San Diego.
Disclosure: de Groot reports being on the faculty at Johnson & Johnson Diabetes Institute Inc.