Abstract
OBJECTIVE To test cognitive behavioral therapy for adherence and depression (CBT-AD) in type 2 diabetes. We hypothesized that CBT-AD would improve adherence; depression; and, secondarily, hemoglobin A1c (A1C). RESEARCH DESIGN AND METHODS Eighty-seven adults with unipolar depression and uncontrolled type 2 diabetes received enhanced treatment as usual (ETAU), including medication adherence, self-monitoring of blood glucose (SMBG), and lifestyle counseling; a provider letter documented psychiatric diagnoses. Those randomized to the intervention arm also received 9-11 sessions of CBT-AD. RESULTS Immediately after acute treatment (4months), adjusting for baseline, CBT-AD had 20.7 percentage points greater oral medication adherence on electronic pill cap (95% CI 231.14 to 210.22, P = 0.000); 30.2 percentage points greater SMBG adherence through glucometer downloads (95% CI 242.95 to 217.37, P = 0.000); 6.44 points lower depression scores on the Montgomery-Asberg Depression Rating Scale (95% CI 2.33-10.56, P = 0.002); 0.74 points lower on the Clinical Global Impression (95% CI 0.16-1.32, P = 0.01); and 0.72 units lower A1C (95% CI 0.29- 1.15, P = 0.001) relative to ETAU. Analyses of 4-, 8-, and 12-month follow-up time points indicated that CBT-AD maintained 24.3 percentage points higher medication adherence (95% CI238.2 to210.3, P = 0.001); 16.9 percentage points greater SMBG adherence (95% CI233.3 to20.5, P = 0.043); and 0.63 units lower A1C (95% CI 0.06-1.2, P = 0.03) after acute treatment ended. For depression, there was some evidence of continued improvement posttreatment, but no between-group differences. CONCLUSIONS CBT-AD is an effective intervention for adherence, depression, and glycemic control, with enduring and clinically meaningful benefits for diabetes selfmanagement and glycemic control in adults with type 2 diabetes and depression.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 625-633 |
| Number of pages | 9 |
| Journal | Diabetes Care |
| Volume | 37 |
| Issue number | 3 |
| DOIs | |
| State | Published - Mar 2014 |
| Externally published | Yes |
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ASJC Scopus subject areas
- Internal Medicine
- Endocrinology, Diabetes and Metabolism
- Advanced and Specialized Nursing
Cite this
A randomized controlled trial of cognitive behavioral therapy for adherence and depression (cbtad) in patientswith uncontrolled type 2 diabetes. / Safren, Steven; Gonzalez, Jeffrey S.; Wexler, Deborah J.; Psaros, Christina; Delahanty, Linda M.; Blashill, Aaron J.; Margolina, Aleksandra I.; Cagliero, Enrico.
In: Diabetes Care, Vol. 37, No. 3, 03.2014, p. 625-633.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - A randomized controlled trial of cognitive behavioral therapy for adherence and depression (cbtad) in patientswith uncontrolled type 2 diabetes
AU - Safren, Steven
AU - Gonzalez, Jeffrey S.
AU - Wexler, Deborah J.
AU - Psaros, Christina
AU - Delahanty, Linda M.
AU - Blashill, Aaron J.
AU - Margolina, Aleksandra I.
AU - Cagliero, Enrico
PY - 2014/3
Y1 - 2014/3
N2 - OBJECTIVE To test cognitive behavioral therapy for adherence and depression (CBT-AD) in type 2 diabetes. We hypothesized that CBT-AD would improve adherence; depression; and, secondarily, hemoglobin A1c (A1C). RESEARCH DESIGN AND METHODS Eighty-seven adults with unipolar depression and uncontrolled type 2 diabetes received enhanced treatment as usual (ETAU), including medication adherence, self-monitoring of blood glucose (SMBG), and lifestyle counseling; a provider letter documented psychiatric diagnoses. Those randomized to the intervention arm also received 9-11 sessions of CBT-AD. RESULTS Immediately after acute treatment (4months), adjusting for baseline, CBT-AD had 20.7 percentage points greater oral medication adherence on electronic pill cap (95% CI 231.14 to 210.22, P = 0.000); 30.2 percentage points greater SMBG adherence through glucometer downloads (95% CI 242.95 to 217.37, P = 0.000); 6.44 points lower depression scores on the Montgomery-Asberg Depression Rating Scale (95% CI 2.33-10.56, P = 0.002); 0.74 points lower on the Clinical Global Impression (95% CI 0.16-1.32, P = 0.01); and 0.72 units lower A1C (95% CI 0.29- 1.15, P = 0.001) relative to ETAU. Analyses of 4-, 8-, and 12-month follow-up time points indicated that CBT-AD maintained 24.3 percentage points higher medication adherence (95% CI238.2 to210.3, P = 0.001); 16.9 percentage points greater SMBG adherence (95% CI233.3 to20.5, P = 0.043); and 0.63 units lower A1C (95% CI 0.06-1.2, P = 0.03) after acute treatment ended. For depression, there was some evidence of continued improvement posttreatment, but no between-group differences. CONCLUSIONS CBT-AD is an effective intervention for adherence, depression, and glycemic control, with enduring and clinically meaningful benefits for diabetes selfmanagement and glycemic control in adults with type 2 diabetes and depression.
AB - OBJECTIVE To test cognitive behavioral therapy for adherence and depression (CBT-AD) in type 2 diabetes. We hypothesized that CBT-AD would improve adherence; depression; and, secondarily, hemoglobin A1c (A1C). RESEARCH DESIGN AND METHODS Eighty-seven adults with unipolar depression and uncontrolled type 2 diabetes received enhanced treatment as usual (ETAU), including medication adherence, self-monitoring of blood glucose (SMBG), and lifestyle counseling; a provider letter documented psychiatric diagnoses. Those randomized to the intervention arm also received 9-11 sessions of CBT-AD. RESULTS Immediately after acute treatment (4months), adjusting for baseline, CBT-AD had 20.7 percentage points greater oral medication adherence on electronic pill cap (95% CI 231.14 to 210.22, P = 0.000); 30.2 percentage points greater SMBG adherence through glucometer downloads (95% CI 242.95 to 217.37, P = 0.000); 6.44 points lower depression scores on the Montgomery-Asberg Depression Rating Scale (95% CI 2.33-10.56, P = 0.002); 0.74 points lower on the Clinical Global Impression (95% CI 0.16-1.32, P = 0.01); and 0.72 units lower A1C (95% CI 0.29- 1.15, P = 0.001) relative to ETAU. Analyses of 4-, 8-, and 12-month follow-up time points indicated that CBT-AD maintained 24.3 percentage points higher medication adherence (95% CI238.2 to210.3, P = 0.001); 16.9 percentage points greater SMBG adherence (95% CI233.3 to20.5, P = 0.043); and 0.63 units lower A1C (95% CI 0.06-1.2, P = 0.03) after acute treatment ended. For depression, there was some evidence of continued improvement posttreatment, but no between-group differences. CONCLUSIONS CBT-AD is an effective intervention for adherence, depression, and glycemic control, with enduring and clinically meaningful benefits for diabetes selfmanagement and glycemic control in adults with type 2 diabetes and depression.
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U2 - 10.2337/dc13-0816
DO - 10.2337/dc13-0816
M3 - Article
VL - 37
SP - 625
EP - 633
JO - Diabetes Care
JF - Diabetes Care
SN - 1935-5548
IS - 3
ER -