Guest Editor

24/02/10

 

In Brief

It is a well-known clinical reality that diabetes and depression are often seen together. What is not so well known or discussed is the phenomenon called “diabetes distress,” usually several feeling states related to depression but not severe enough to be diagnosed as such. This article explores the phenomenon of diabetes distress and offer clinicians some assessment and treatment intervention strategies.

 

In Brief

Patients with type 1 or type 2 diabetes are two times more likely to experience depression than their peers without diabetes. Comorbid depression results in deleterious effects on glycemic control, worsened diabetes complications, functional disability, and premature mortality. Once identified, depression can be effectively treated with antidepressant medications, psychotherapy, or a combination of both. Patients and providers should monitor depressive symptoms to identify their recurrence and work collaboratively to address barriers to care that exist in both urban and rural areas.

 

In Brief

Depression affects one in four people with diabetes and significantly affects diabetes health. Earlier studies of the treatment of depression have documented that cognitive behavioral therapy (CBT) and exercise have each been found to be effective in treating depression in people with and without diabetes in the context of medical settings. Individuals in rural areas lack regular access to medical centers and require treatment options that may be adapted for local communities. To date, no studies have combined CBT and exercise for people with diabetes. This article presents a translational behavioral depression intervention study designed for individuals with type 2 diabetes in a rural Appalachian region as a model of an interdisciplinary approach to the treatment of depression in diabetes.

 

In Brief

Among patients with type 1 or type 2 diabetes, depression is one of the most commonly occurring comorbid conditions. A dual diagnosis of depression and diabetes has been linked to poor adherence and decreased daily diabetes self-care and often leads to suboptimal metabolic control and increased diabetes-related complications. Pediatric diabetes clinicians are in a unique position to identify behavior changes over time and provide early identification and preventive intervention for children and adolescents at risk for depression. This article provides an overview of the differential diagnosis process that pediatric clinicians face and practical advice for providers when evaluating and addressing depressive symptoms during routine diabetes clinic visits.

 

In Brief

This article reviews research related to living with depression and diabetes in the post—high school and young-adult periods. Clinical lessons for pediatric and adult diabetes care providers are distilled from this evidence base.

 

Objective. This study examines the relationship between receiving diabetes self-management education (DSME) and having higher levels of comprehensive diabetes clinical care, a summation of up to five clinical services recommended for individuals with type 2 diabetes and those who have had type 1 diabetes for ≥ 5 years.

Design. Analysis of data from a population-based, cross-sectional study.

Methods. Data for this study were from the 2007 Florida Behavioral Risk Factor Surveillance System (BRFSS), a statewide, random, cross-sectional survey of adults. A dichotomous comprehensive diabetes clinical care variable was constructed based on responses to questions from the BRFSS diabetes module, and a logistic regression model was fitted. Adjusted odds ratios (ORs) are reported.

Results. Among Florida adults with diabetes, 51.5% had received DSME. About 51.4% of adults with diabetes who received DSME had a high level of comprehensive care compared to 31.8% of those who did not receive DSME. The OR for having a high level of comprehensive care was statistically significantly higher among adults who received DSME (OR = 2.48) compared to their counterparts who did not receive DSME. Other significant covariates were having health insurance (OR = 3.65), having graduated from high school (OR = 1.55), having a college education (OR = 2.70), being 45-64 years of age (OR = 2.31), and being ≥ 65 years of age (OR = 5.29).

Conclusions. These data show that receiving DSME is positively associated with receiving higher levels of comprehensive diabetes clinical care.

 
 
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