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

Dominique Musselman, David C. Ziemer, Marcia D. McNutt, Julia 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

11 Citations (Scopus)

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

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African Americans
Type 2 Diabetes Mellitus
Self Care
Glycosylated Hemoglobin A
Interviews
Insulin
Therapeutics
Type 2 Diabetes
Diabetes
Self-management

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)

Cite this

Depression, deficits in functional capacity, and impaired glycemic control in urban African Americans with type 2 diabetes. / Musselman, Dominique; Ziemer, David C.; McNutt, Marcia D.; Seay, Julia; Royster, Erica B.; Larsen, Bridget; Barham, Terrika; Brown, Angelo R.; Vogel, Octavia L.; Phillips, Lawrence S.; Harvey, Philip D.

In: Journal of Psychiatric Research, Vol. 52, No. 1, 01.01.2014, p. 21-27.

Research output: Contribution to journalArticle

Musselman, Dominique ; Ziemer, David C. ; McNutt, Marcia D. ; Seay, Julia ; Royster, Erica B. ; Larsen, Bridget ; Barham, Terrika ; Brown, Angelo R. ; Vogel, Octavia L. ; Phillips, Lawrence S. ; Harvey, Philip D. / Depression, deficits in functional capacity, and impaired glycemic control in urban African Americans with type 2 diabetes. In: Journal of Psychiatric Research. 2014 ; Vol. 52, No. 1. pp. 21-27.
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T1 - Depression, deficits in functional capacity, and impaired glycemic control in urban African Americans with type 2 diabetes

AU - Musselman, Dominique

AU - Ziemer, David C.

AU - McNutt, Marcia D.

AU - Seay, Julia

AU - Royster, Erica B.

AU - Larsen, Bridget

AU - Barham, Terrika

AU - Brown, Angelo R.

AU - Vogel, Octavia L.

AU - Phillips, Lawrence S.

AU - Harvey, Philip D

PY - 2014/1/1

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N2 - 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.

AB - 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.

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