Skip to main content

Advertisement

Log in

Improvement in glycemic control following a diabetes education intervention is associated with change in diabetes distress but not change in depressive symptoms

  • Published:
Journal of Behavioral Medicine Aims and scope Submit manuscript

Abstract

In diabetes patients, depression is correlated with diabetes-specific emotional distress, and observational studies have suggested that diabetes distress may have a greater impact on diabetes outcomes than depression itself. To examine the relative effects of change in depressive symptoms and change in diabetes distress on change in glycemic control, we conducted a diabetes self-management education intervention in 234 type 2 diabetes (T2DM) patients, and measured glycemic control (HbA1c), depressive symptoms (CES-D), and diabetes distress (PAID) at baseline and 6 months. In multiple linear regression, change in depressive symptoms was not associated with change in HbA1c (P = 0.23). Change in diabetes distress was significantly associated with change in HbA1c (P < 0.01), such that a 10-point decrease in diabetes distress (which corresponds to the average change in distress in this study population) was associated with a 0.25% reduction in HbA1c. Change in diabetes distress, and not change in depressive symptoms, was associated with both short- and long-term change in glycemic control for patients with poorly controlled T2DM.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • Aikens, J. E., Perkins, D. W., Lipton, B., & Piette, J. D. (2009). Longitudinal analysis of depressive symptoms and glycemic control in type 2 diabetes. Diabetes Care, 32, 1177–1181.

    Article  PubMed  Google Scholar 

  • Ali, S., Stone, M. A., Peters, J. L., Davies, M. J., & Khunti, K. (2006). The prevalence of co-morbid depression in adults with type 2 diabetes: A systematic review and meta-analysis. Diabetic Medicine: A Journal of the British Diabetic Association, 23, 1165–1173.

    Article  CAS  Google Scholar 

  • Bradley, C. (1999). Diabetes treatment satisfaction questionnaire. Change version for use alongside status version provides appropriate solution where ceiling effects occur. Diabetes Care, 22, 530–532.

    Article  PubMed  CAS  Google Scholar 

  • Cherrington, A., Wallston, K. A., & Rothman, R. L. (2010). Exploring the relationship between diabetes self-efficacy, depressive symptoms, and glycemic control among men and women with type 2 diabetes. Journal of Behavioral Medicine, 33, 81–89.

    Article  PubMed  Google Scholar 

  • Cohen, S. T., Welch, G., Jacobson, A. M., De Groot, M., & Samson, J. (1997). The association of lifetime psychiatric illness and increased retinopathy in patients with type I diabetes mellitus. Psychosomatics, 38, 98–108.

    Article  PubMed  CAS  Google Scholar 

  • de Groot, M., Jacobson, A. M., Samson, J. A., & Welch, G. (1999). Glycemic control and major depression in patients with type 1 and type 2 diabetes mellitus. Journal of Psychosomatic Research, 46, 425–435.

    Article  PubMed  Google Scholar 

  • Eaton, W. W., Mengel, M., Mengel, L., Larson, D., Campbell, R., & Montague, R. B. (1992). Psychosocial and psychopathologic influences on management and control of insulin-dependent diabetes. International Journal of Psychiatry in Medicine, 22, 105–117.

    Article  PubMed  CAS  Google Scholar 

  • Egede, L. E., & Ellis, C. (2010). Diabetes and depression: Global perspectives. Diabetes Research and Clinical Practice, 87, 302–312.

    Article  PubMed  Google Scholar 

  • Fisher, L., Mullan, J. T., Arean, P., Glasgow, R. E., Hessler, D., & Masharani, U. (2010). Diabetes distress but not clinical depression or depressive symptoms is associated with glycemic control in both cross-sectional and longitudinal analyses. Diabetes Care, 33, 23–28.

    Article  PubMed  Google Scholar 

  • Fisher, L., Skaff, M. M., Mullan, J. T., Arean, P., Glasgow, R., & Masharani, U. (2008). A longitudinal study of affective and anxiety disorders, depressive affect and diabetes distress in adults with type 2 diabetes. Diabetic Medicine: A Journal of the British Diabetic Association, 25, 1096–1101.

    Article  CAS  Google Scholar 

  • Georgiades, A., Zucker, N., Friedman, K. E., Mosunic, C. J., Applegate, K., Lane, J. D., et al. (2007). Changes in depressive symptoms and glycemic control in diabetes mellitus. Psychosomatic Medicine, 69, 235–241.

    Article  PubMed  CAS  Google Scholar 

  • Glasgow, R. E., Toobert, D. J., Barrera, M., Jr, & Strycker, L. A. (2004). Assessment of problem-solving: A key to successful diabetes self-management. Journal of Behavioral Medicine, 27, 477–490.

    Article  PubMed  Google Scholar 

  • Kokoszka, A., Pouwer, F., Jodko, A., Radzio, R., Mucko, P., Bienkowska, J., et al. (2009). Serious diabetes-specific emotional problems in patients with type 2 diabetes who have different levels of comorbid depression: A Polish study from the European depression in diabetes (EDID) research consortium. European Psychiatry: The Journal of the Association of European Psychiatrists, 24, 425–430.

    CAS  Google Scholar 

  • Konen, J. C., Curtis, L. G., & Summerson, J. H. (1996). Symptoms and complications of adult diabetic patients in a family practice. Archives of Family Medicine, 5, 135–145.

    Article  PubMed  CAS  Google Scholar 

  • Lin, E. H., Rutter, C. M., Katon, W., Heckbert, S. R., Ciechanowski, P., Oliver, M. M., et al. (2010). Depression and advanced complications of diabetes: A prospective cohort study. Diabetes Care, 33, 264–269.

    Article  PubMed  Google Scholar 

  • Lustman, P. J., Anderson, R. J., Freedland, K. E., de Groot, M., Carney, R. M., & Clouse, R. E. (2000). Depression and poor glycemic control: A meta-analytic review of the literature. Diabetes Care, 23, 934–942.

    Article  PubMed  CAS  Google Scholar 

  • Lustman, P. J., Griffith, L. S., Clouse, R. E., & Cryer, P. E. (1986). Psychiatric illness in diabetes mellitus. Relationship to symptoms and glucose control. The Journal of Nervous and Mental Disease, 174, 736–742.

    Article  PubMed  CAS  Google Scholar 

  • Mazze, R. S., Lucido, D., & Shamoon, H. (1984). Psychological and social correlates of glycemic control. Diabetes Care, 7, 360–366.

    Article  PubMed  CAS  Google Scholar 

  • Petrak, F., & Herpertz, S. (2009). Treatment of depression in diabetes: An update. Current Opinion in Psychiatry, 22, 211–217.

    Article  PubMed  Google Scholar 

  • Polonsky, W. H., Anderson, B. J., Lohrer, P. A., Welch, G., Jacobson, A. M., Aponte, J. E., et al. (1995). Assessment of diabetes-related distress. Diabetes Care, 18, 754–760.

    Article  PubMed  CAS  Google Scholar 

  • Pouwer, F. (2009). Should we screen for emotional distress in type 2 diabetes mellitus? Nature Reviews Endocrinology, 5, 665–671.

    Article  PubMed  Google Scholar 

  • Pouwer, F., Skinner, T. C., Pibernik-Okanovic, M., Beekman, A. T., Cradock, S., Szabo, S., et al. (2005). Serious diabetes-specific emotional problems and depression in a Croatian-Dutch-English survey from the European depression in diabetes [EDID] research consortium. Diabetes Research and Clinical Practice, 70, 166–173.

    Article  PubMed  Google Scholar 

  • Radloff, L. S. (1977). The CES-D scale: A self-report depression scale for research in the general population. Applied Psychological Measurement, 1, 385–401.

    Article  Google Scholar 

  • Solowiejczyk, J. (2010). Diabetes and depression: Some thoughts to think about. Diabetes Spectrum, 23, 11–15.

    Article  Google Scholar 

  • Thomas, J. L., Jones, G. N., Scarinci, I. C., Mehan, D. J., & Brantley, P. J. (2001). The utility of the CES-D as a depression screening measure among low-income women attending primary care clinics. The center for epidemiologic studies-depression. International Journal of Psychiatry in Medicine, 31, 25–40.

    Article  PubMed  CAS  Google Scholar 

  • van Bastelaar, K. M., Pouwer, F., Geelhoed-Duijvestijn, P. H., Tack, C. J., Bazelmans, E., Beekman, A. T., et al. (2010). Diabetes-specific emotional distress mediates the association between depressive symptoms and glycaemic control in type 1 and type 2 diabetes. Diabetic Medicine: A Journal of the British Diabetic Association, 27, 798–803.

    Article  Google Scholar 

  • Van der Does, F. E., De Neeling, J. N., Snoek, F. J., Kostense, P. J., Grootenhuis, P. A., Bouter, L. M., et al. (1996). Symptoms and well-being in relation to glycemic control in type II diabetes. Diabetes Care, 19, 204–210.

    Article  PubMed  Google Scholar 

  • van der Feltz-Cornelis, C. M., Nuyen, J., Stoop, C., Chan, J., Jacobson, A. M., Katon, W., et al. (2010). Effect of interventions for major depressive disorder and significant depressive symptoms in patients with diabetes mellitus: A systematic review and meta-analysis. Annals of General Hospital Psychiatry, 32, 380–395.

    Article  Google Scholar 

  • Van Tilburg, M. A., McCaskill, C. C., Lane, J. D., Edwards, C. L., Bethel, A., Feinglos, M. N., et al. (2001). Depressed mood is a factor in glycemic control in type 1 diabetes. Psychosomatic Medicine, 63, 551–555.

    PubMed  Google Scholar 

  • Wang, M. Y., Tsai, P. S., Chou, K. R., & Chen, C. M. (2008). A systematic review of the efficacy of non-pharmacological treatments for depression on glycaemic control in type 2 diabetics. Journal of Clinical Nursing, 17, 2524–2530.

    Article  PubMed  Google Scholar 

  • Weinger, K., Butler, H. A., Welch, G. W., & La Greca, A. M. (2005). Measuring diabetes self-care: A psychometric analysis of the self-care inventory-revised with adults. Diabetes Care, 28, 1346–1352.

    Article  PubMed  Google Scholar 

  • Welch, G. W., Jacobson, A. M., & Polonsky, W. H. (1997). The problem areas in diabetes scale. An evaluation of its clinical utility. Diabetes Care, 20, 760–766.

    Article  PubMed  CAS  Google Scholar 

  • Welch, G., Weinger, K., Anderson, B., & Polonsky, W. H. (2003). Responsiveness of the problem areas in diabetes (PAID) questionnaire. Diabetic Medicine: A Journal of the British Diabetic Association, 20, 69–72.

    Article  CAS  Google Scholar 

  • Welch, G., Zagarins, S. E., Feinberg, R. G., & Garb, J. L. (2010). Motivational interviewing delivered by diabetes educators: Does it improve blood glucose control among poorly controlled type 2 diabetes patients? Diabetes Research and Clinical Practice (in press).

Download references

Acknowledgments

This research was supported by National Institutes of Health grant #1R01DK060076.

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Sofija E. Zagarins.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Zagarins, S.E., Allen, N.A., Garb, J.L. et al. Improvement in glycemic control following a diabetes education intervention is associated with change in diabetes distress but not change in depressive symptoms. J Behav Med 35, 299–304 (2012). https://doi.org/10.1007/s10865-011-9359-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10865-011-9359-z

Keywords

Navigation