Depression, deficits in functional capacity, and impaired glycemic control in urban African Americans with type 2 diabetes

Dominique L. Musselman, David C. Ziemer, Marcia D. McNutt, Julia S. Seay, Erica B. Royster, Bridget Larsen, Terrika Barham, Angelo R. Brown, Octavia L. Vogel, Lawrence S. Phillips, Philip D. Harvey

Research output: Contribution to journalArticle

13 Scopus citations

Abstract

Background: Effective depression treatment does not reliably reduce glycosylated hemoglobin (HbA1c) in depressed patients with type 2 diabetes, possibly in part due to deficits in functional capacity, i.e. performance of certain everyday living skills, essential for effective diabetes self-management. We sought to determine: a) the magnitude of deficits in functional capacity among urban, African American (AA) patients with type 2 diabetes, and b) whether these deficits were associated with poorer glycemic control. Methods: At their initial visit to an inner-city diabetes clinic, 172 AA patients with type 2 diabetes were assessed with a variety of instruments, including the Mini International Neuropsychiatric Interview (MINI) and the UCSD Performance Skills Assessment-Brief (UPSA-B). They then entered a comprehensive diabetes management intervention, whose success was indexed by HbA1c levels at up to four reassessments over a one-year period. A mixed-effects model repeated-measures method was used to predict HbA1c. Results: The prevalence of depression was 19%; the mean UPSA-B score was 81±17. After multivariate adjustment, increased HbA1c levels over time were predicted by the presence of major depression ( B=911, p=002) and decreasing (worse) scores on the UPSA-B ( B=-016, p=027), respectively. Further adjustment for increasing the dosage of oral or insulin during the treatment eliminated the association between the UPSA score and HbA1c level ( B=-010, p=115). Conclusions: Depression, as well as deficits in functional capacity, predicted reduced effectiveness of a diabetes self-management intervention. Future studies will determine whether interventions targeted at both improve glycemic control.

Original languageEnglish (US)
Pages (from-to)21-27
Number of pages7
JournalJournal of Psychiatric Research
Volume52
Issue number1
DOIs
StatePublished - Jan 1 2014

Keywords

  • African Americans
  • Functional capacity
  • Glycemic control
  • HbA1c
  • Major depression
  • MINI structured diagnostic interview
  • Neurocognition
  • Type 2 diabetes
  • UPSA-B
  • Zung Depression Rating Scale

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Biological Psychiatry
  • Arts and Humanities (miscellaneous)

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