A randomized controlled trial of cognitive behavioral therapy for adherence and depression (cbtad) in patientswith uncontrolled type 2 diabetes

Steven Safren, Jeffrey S. Gonzalez, Deborah J. Wexler, Christina Psaros, Linda M. Delahanty, Aaron J. Blashill, Aleksandra I. Margolina, Enrico Cagliero

Research output: Contribution to journalArticle

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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 languageEnglish (US)
Pages (from-to)625-633
Number of pages9
JournalDiabetes Care
Volume37
Issue number3
DOIs
StatePublished - Mar 2014
Externally publishedYes

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Cognitive Therapy
Type 2 Diabetes Mellitus
Randomized Controlled Trials
Depression
Blood Glucose Self-Monitoring
Medication Adherence
Therapeutics
Mental Disorders
Life Style
Counseling
Hemoglobins
Research Design

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 journalArticle

Safren, S, Gonzalez, JS, Wexler, DJ, Psaros, C, Delahanty, LM, Blashill, AJ, Margolina, AI & Cagliero, E 2014, 'A randomized controlled trial of cognitive behavioral therapy for adherence and depression (cbtad) in patientswith uncontrolled type 2 diabetes', Diabetes Care, vol. 37, no. 3, pp. 625-633. https://doi.org/10.2337/dc13-0816
Safren, Steven ; Gonzalez, Jeffrey S. ; Wexler, Deborah J. ; Psaros, Christina ; Delahanty, Linda M. ; Blashill, Aaron J. ; Margolina, Aleksandra I. ; Cagliero, Enrico. / A randomized controlled trial of cognitive behavioral therapy for adherence and depression (cbtad) in patientswith uncontrolled type 2 diabetes. In: Diabetes Care. 2014 ; Vol. 37, No. 3. pp. 625-633.
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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.",
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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

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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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