Easing Depression Won't Improve Diabetes Care

Boosting mental health may be just first step toward better self-care, study finds

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By Meryl Hyman Harris
HealthDay Reporter

FRIDAY, Feb. 3, 2006 (HealthDay News) -- Diabetics who are treated for depression don't manage their disease better, a new study has found.

"Curing the depression won't change lifelong habits for most people," said study co-author Dr. Wayne Katon, a professor of psychiatry at the University of Washington in Seattle.

However, once the depression is under control, it is hoped that behavioral therapy aimed specifically at encouraging patients to take their medications and exercise will be effective, he said.

The study appears in the January/February issue of the Annals of Family Medicine.

The prevalence of depression is roughly twice as high among diabetic patients as it is among the general population, and depressed diabetics die of the blood sugar illness at twice the rate of non-depressed diabetic patients, experts noted.

Katon and his colleagues wondered if easing depression might improve diabetics' self-care.

They followed the 12-month progress of 329 diabetic patients at nine primary-care clinics who were also treated for depression.

Even after receiving standard therapies such as antidepressants or psychotherapy, treated patients showed no improvement in terms of increased physical activity, taking their medications regularly, quitting smoking or paying closer attention to their nutrition, the researchers found.

The American Diabetes Association estimates that about 21 million people suffer from diabetes. A small minority has an inherited form of the disease, called type 1, where the pancreas does not produce sufficient insulin. The vast majority of diabetics (95 percent) suffer from type 2 diabetes, usually linked to being overweight. In type 2 disease, the body's cells gradually lose their sensitivity to insulin.

Diabetics who do not or cannot manage their blood sugar risk heart disease, stroke, blindness, kidney problems, nerve damage, teeth and gum disease, decreased sexual function and amputation, according to the National Institutes of Health.

But sticking to the strict, healthy lifestyle that diabetes demands can be tough.

"In diabetes, a healthy weight and physical activity really help improve blood sugars, and the kinds of food you eat and how much [you eat] does, too," said Cathy Nonas, director of the obesity and diabetes program at North General Hospital, in New York City.

"One of the nice things is we have more and more medication, but it never works as well alone as with these lifestyle changes," she said. Added to that is the fact that "people are frequently not long-term compliant with taking their medications."

According to the study, the double whammy of diabetes and depression appears to make controlling either condition more difficult.

"Just as effective diabetes management may be compromised by depression and associated characteristics, such as pessimism and fatigue, effective depression management may also be undermined by symptoms of poor diabetes control, such as neuropathic pain and functional disability," the Seattle authors concluded.

"Depression is both a cause and effect of diabetes," Katon explained. People with depression are often less likely to exercise and eat healthily, and may also have chemical complications that contribute to the onset of diabetes later on.

But rather than portraying the findings as bad news, he pointed out that treating patients does ease the symptoms of depression. That alone is a "necessary first step" in helping them care for themselves, Katon said.

More information

Learn much more about diabetes and how to control it at the American Diabetes Association.

SOURCES: Wayne Katon, M.D. professor, psychiatry, University of Washington, Seattle; Cathy Nonas, M.S., R.D., C.D.E., director, obesity and diabetes program, North General Hospital, New York City, and spokeswoman, American Dietetic Association; January/February 2006 Annals of Family Medicine

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