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Cognitive behavioral therapy for adherence and depression

People with diabetes have an increased incidence of depression, but standard treatments have had mixed results on diabetes-related outcomes. Cognitive behavioural therapy (CBT) is becoming more commonly available in primary care. In a recently published study, researchers showed that a course of CBT that addresses both mood and diabetes self-care led to improved blood glucose control and produced a faster relief of depression in people with poorly controlled type 2 diabetes.

by Colin Kenny, GP, Dromore

 

Depression is more than twice as common in people with diabetes and this is thought to contribute to reduced levels of diabetes control. Investigators in Massachusetts, USA, enrolled 87 adults whose type 2 diabetes was poorly controlled despite treatment with oral medications, and who also met the agreed criteria for the diagnosis of depression. A subgroup of 45 randomly selected participants took part in 9–12 additional weekly cognitive behavioural therapy sessions, where they worked on problem-solving strategies, reviewed how well they met goals of the previous week, and tracked their moods. 

The study progressed over 1 year and both groups received appropriate antidepressant medication. At the end of this time participants receiving the CBT treatment were significantly more successful than the usual-treatment group in adhering to their prescribed medications and their glucose-monitoring schedule. They also showed an improvement in blood glucose control similar to what might be seen with the addition of a weak glucose-lowering medication. The researchers had caveats about cost-effectiveness but thought that the CBT intervention could be helpful in treating any medical illness in which patients also have depression.

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