0

The full content of Annals is available to subscribers

Subscribe/Learn More  >
Articles |

Cognitive Behavior Therapy for Depression in Type 2 Diabetes Mellitus: A Randomized, Controlled Trial

Patrick J. Lustman, PhD; Linda S. Griffith, MSW; Kenneth E. Freedland, PhD; Sarah S. Kissel, RN, CDE; and Ray E. Clouse, MD
[+] Article and Author Information

From Washington University School of Medicine and the Veterans Affairs Medical Center, St. Louis, Missouri. Acknowledgments: The authors thank Julio Santiago, MD, for support and technical assistance; Michael Province, PhD, for statistical advice; and Kathleen McAleenan, MSW, and Linda Lawrence, MEd, for assistance with data collection. Grant Support: In part by a clinical research grant from the American Diabetes Association (Dr. Lustman) and grant R21 MH 52629 from the National Institute of Mental Health (Dr. Freedland). Requests for Reprints: Patrick J. Lustman, PhD, Department of Psychiatry, Washington University School of Medicine, 4940 Children's Place, St. Louis, MO 63110. Current Author Addresses: Drs. Lustman and Freedland and Ms. Griffith: Department of Psychiatry, Washington University School of Medicine, 4940 Children's Place, St. Louis, MO 63110.


Copyright ©2004 by the American College of Physicians


Ann Intern Med. 1998;129(8):613-621. doi:10.7326/0003-4819-129-8-199810150-00005
Text Size: A A A

Background: Psychotherapy is the principal nonpharmacologic method for the management of depression, but its usefulness for depressed patients with diabetes remains unknown.

Objective: To assess the efficacy of cognitive behavior therapy (CBT) for depression in patients with diabetes.

Design: Randomized, controlled trial.

Setting: Referral-based academic medical center.

Patients: 51 patients with type 2 diabetes and major depression.

Intervention: Patients were assigned either to a group that received 10 weeks of individual CBT or to a control group that received no specific antidepressant treatment. All patients participated in a diabetes education program to control for the effects of supportive attention and the possible influence of enhanced diabetes control on mood.

Measurements: Degree of depression was measured by using the Beck Depression Inventory; glycemic control was measured by using glycosylated hemoglobin levels. Outcomes were assessed immediately after treatment and 6 months after treatment.

Results: The percentage of patients achieving remission of depression (Beck Depression Inventory score ≤ 9) was greater in the CBT group than in the control group: posttreatment, 85.0% of patients in the CBT group (17 of 20) compared with 27.3% of controls (6 of 22) achieved remission (difference, 57.7 percentage points [95% CI, 33 to 82 percentage points]) (P < 0.001); at follow-up, 70.0% of patients in the CBT group (14 of 20) compared with 33.3% of controls (7 of 21) achieved remission (difference, 36.7 percentage points [CI, 9 to 65 percentage points]) (P = 0.03). Post-treatment glycosylated hemoglobin levels were not different in the two groups, but follow-up mean glycosylated hemoglobin levels were significantly better in the CBT group than in the control group (9.5% compared with 10.9%; P = 0.03).

Conclusions: The combination of CBT and supportive diabetes education is an effective nonpharmacologic treatment for major depression in patients with type 2 diabetes. It may also be associated with improved glycemic control.

Figures

Grahic Jump Location
Figure 1.
Study participation data.

CBT = cognitive behavior therapy; R = randomization.

Grahic Jump Location
Grahic Jump Location
Figure 2.
Percentages of patients with depression in remission and those with significantly improved depression at post-treatment and follow-up evaluations.PPPP

A Beck Depression Inventory score of 9 or less was used to define remission; a score equal to 50% or less of the score before treatment was used to define improvement. A greater percentage of patients receiving cognitive behavior therapy (CBT) had remission or improvement at post-treatment and follow-up evaluations. Forty-two patients (20 in the CBT group and 22 controls) had post-treatment evaluation; 41 patients (20 in the CBT group and 21 controls) had 6-month evaluation. White bars represent the CBT group; striped bars represent controls. *  < 0.001; **  = 0.01; +  = 0.03; ++  = 0.04.

Grahic Jump Location
Grahic Jump Location
Figure 3.
Absolute change in glycosylated hemoglobin (GHb) levels from pretreatment to post-treatment evaluations and from post-treatment to follow-up evaluations.P

Improvement in GHb levels during the follow-up interval was greater in the group receiving cognitive behavioral therapy (CBT) than in controls. Forty-two patients (20 in the CBT group and 22 controls) were evaluated immediately after treatment; 42 patients (20 in the CBT group and 21 controls) were evaluated at 6 months. White bars represent the CBT group; striped bars represent controls. *  = 0.04.

Grahic Jump Location
Grahic Jump Location
Figure 4.
Compliance with the protocol for self-monitoring of blood glucose levels (SMBG).P

Over the 10-week treatment period, compliance declined in the group receiving cognitive behavioral therapy (CBT) compared with controls ( = 0.01). White bars represent the CBT group; striped bars represent controls.

Grahic Jump Location

Tables

References

Letters

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Comments

Submit a Comment
Submit a Comment

Summary for Patients

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.

Toolkit

Buy Now

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Advertisement
Related Articles
Related Point of Care
Topic Collections
PubMed Articles
[Type 2 diabetes complications]. Presse Med 2013;42(5):839-48.
A "glucose eater" drug as a therapeutic agent in psychiatry. J Psychosoc Nurs Ment Health Serv 2013;51(9):13-6.

Buy Now

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.
(Required)
(Required)