[FOR EMBARGOED RELEASE Wednesday, April 7]
Contact: Terry Bush, 206-876-2201 (w); 206-331-7216 (cell)

Can we achieve a world without diabetes? Addressing health risk behaviors and depression.

SEATTLE, WA - According to Wayne Katon, MD from the University of Washington Medical School, patients with comorbid depression and diabetes compared to those with diabetes alone were found to have poorer adherence to disease control medications but no significant differences in control of HbA1c, LDL or blood pressure. Dr. Katon conducted a 5-year prospective study that examined bidirectional links between depression and diabetes among 4000 patients with diabetes enrolled in a large HMO. The study showed that those with comorbid depression and diabetes, compared to patients with diabetes alone, had an approximately 35% higher risk of subsequent microvascular and macrovascular complications and 50% greater risk of mortality over a 5-year period. Those with either persistent or worsening depressive symptoms compared to those in the no depression group had significantly fewer days per week of following a healthy diet or participating in 30 or more minutes of exercise. At 5-year follow-up, patients with clinical improvement in depression symptoms did not differ from the non-depressed group on number of days per week of adherence to diet but showed deterioration in adherence to exercise on some, but not all, measures.

These findings suggest that biologic mechanisms such as abnormalities in cytokine levels are important to study to enhance understanding about the adverse impact of depression in patients with diabetes. Dr. Katon is also discussing results from three recent trials of collaborative depression care versus usual primary care showing improvements in quality of depression care, depression and physical functioning outcomes, but no differences in HbA1c levels over a 12-month period. Collaborative care was associated with a significantly increased number of depression-free days and decreased total medical costs over a 24-month period. Finally, Dr. Katon will present results on a new model of care, called TEAMcare, that has integrated depression and medical care management into the treatment of patients with diabetes and/or heart disease who have poor medical disease control and has been found to improve depressive, HbA1c, LDL and systolic blood pressure outcomes.

Smokers who have diabetes are more likely to be depressed than smokers without diabetes and although they have similar success quitting smoking, they are more likely to gain weight. A study led by Terry Bush, Ph.D, Associate Investigator at Free and Clear, recruited smokers who called the Washington State Tobacco Quit Line (WAQL) and compared those with diabetes to matched controls on the use and effectiveness of the quitline. In 2008, 8.5% of the 9190 smokers who called the quitline had diabetes. Smokers with diabetes were significantly different from smokers without diabetes. They were older, more likely to be obese, more likely to be depressed, and to have smoked for 20+ years. They made more visits to a health care provider (HCP) and were more likely to report being advised to quit smoking, to lose weight, and to follow a special diet/exercise plan compared with controls. At 7 months, groups did not differ in treatment satisfaction or quit rates, but among those who quit smoking those with diabetes were more likely to gain weight; 52% of cases vs. 36% of controls gained weight averaging 23.2 vs.14.7 pounds.

Jennifer Lovejoy, PhD from Free and Clear is providing an overview of innovative interventions shown to prevent the onset and exacerbation of diabetes. She will present a list of recommendations that includes a call for routine screening of diabetes patients for depression, obesity and smoking and to continued research on the development and dissemination of interventions in treating depression, improving lifestyle, self-care and diabetes outcomes. Comprehensive interventions that target depression along with health behaviors such as treatment adherence, physical activity, diet, and smoking are most likely to maximize effects on diabetes outcomes.

The Society of Behavioral Medicine is a multidisciplinary organization of clinicians, educators and scientists dedicated to promoting the study of the interactions of behavior with biology and the environment and the application of that knowledge to improve the health and well being of individuals, families, communities and populations.
www.sbm.org

Editor’s notes:
This study was presented during the 2010 Annual Meeting and Scientific Sessions of the Society of Behavioral Medicine (SBM) from April 7-10 in Seattle, Washington. However, it does not necessarily reflect the policies or the opinion of the SBM

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