Frequently, depression and diabetes go hand in hand. And depression can be a major obstacle for people living with diabetes, making it less likely they’ll stick to a medicine schedule or exercise regimen.
A team of researchers led by investigators at the VA Ann Arbor Healthcare System and the University of Michigan Health System worked to improve diabetes patients’ health by first addressing their depression. The study evaluated a year-long program that began with behavioral therapy sessions over the telephone with a specially trained nurse and later phased in a walking program.
Their findings, published online ahead of print in Medical Care, showed the intervention was successful in lowering patients’ blood pressure, increasing their physical activity by about four miles of walking per week and easing their depressive symptoms.
“Depression is a common, treatable issue for many people who have diabetes,” says study lead author John Piette, Ph.D., a senior research scientist at the VA and professor of internal medicine at the U-M Medical School. “Unfortunately, most busy clinics cannot provide the level of intensive care these patients need. This study shows that telephone-delivered counseling can improve patients’ access to effective depression care, improve their cardiovascular health and get them moving again.”
The cognitive behavior therapy helped the study participants address negative thought processes and behaviors that made it difficult for them to manage their diabetes and make healthy lifestyle choices, Piette says.
The physical activity component of the program used pedometers to help patients set walking goals and monitor their progress. Along with physical benefits, exercise also helps boost one’s mood.
Most patients entered the study with relatively good blood glucose control. So while the intervention did not lead to a drop in A1C, a common measurement of blood glucose levels, patients did see more than a 4-point improvement in their systolic blood pressure, walked about half a mile more per day and reported an improvement in their general quality of life.
At the end of the year, 58 percent of patients who received the intervention had depression symptoms that were in remission, compared to only 39 percent of the patients who did not receive counseling.
“Health systems should consider routinely offering structured telephone psychotherapy to their patients with diabetes and depression,” says senior study author Marcia Valenstein, M.D., M.S., an associate professor of psychiatry at the U-M Medical School and VA research scientist. “Patients with depression and additional chronic medical conditions do better if their depression is addressed first, if it is addressed systematically, and if exercise is also encouraged. Delivering therapy by telephone makes it feasible to reach large numbers of patients who may not attend traditional in-person appointments.”
Methods: 291 patients with type 2 diabetes and significant depressive symptoms completed the study; 145 received the intervention, which consisted of 12 weeks of cognitive behavioral therapy over the phone, followed by nine monthly “booster” sessions. After six weeks, a pedometer-based walking program was introduced. Depression, coping and quality-of-life measurements were taken using standardized scales.
Funding: The research was funded by grants from the National Institutes of Health, Michigan Diabetes Research and Training Center and the Michigan Institute for Clinical and Health Research.
Additional authors: Caroline Richardson, M.D., of U-M and VA; Sonia Duffy, Ph.D., of U-M and VA; Joseph Himle, Ph.D., of U-M; and Trissa Torres, M.D.; Mark Vogel, Ph.D.; and Kimberly Barber, Ph.D., all of Genesys Health System, Flint, Mich.
Citation: “A Randomized Trial of Telephonic Counseling Plus Walking for Depressed Diabetes Patients,” Medical Care. doi: 10.1097/MLR.0b013e318215d0c9