Stephanie J Czech1, Susan M Orsillo2, Paul A Pirraglia3, Thomas M English4, Alexa J Connell5. 1. Department of Psychiatry, Rhode Island Hospital, Providence. 2. Department of Psychology, Suffolk University, Boston, Massachusetts. 3. Primary Care, Providence VA Medical Center and Alpert Medical School, Brown University, Providence, Rhode Island. 4. Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester. 5. Department of Family Medicine and Community Health, University of Massachusetts Medical School, Worcester.
Abstract
OBJECTIVE: To determine whether specific depression symptoms are associated with glycemic control independent of potential demographic and clinical covariates among primary care patients with comorbid type 2 diabetes and provisional threshold or subthreshold depression. METHOD: We examined a convenience sample of patients diagnosed with type 2 diabetes and provisional threshold or subthreshold depression (N = 82) at 2 family health centers. Cases were identified using a population-based registry of patients diagnosed with type 2 diabetes (ICD-9 codes 250.00 for controlled type 2 diabetes and 250.02 for uncontrolled type 2 diabetes). Data from patients with a primary care provider appointment from the beginning of April 2011 through the end of June 2012 and with at least one 9-item Patient Health Questionnaire (PHQ-9) depression screener and a glycated hemoglobin A1c (HbA1c) laboratory test between 2 weeks before and 10 weeks after PHQ-9 screening were eligible for inclusion. We defined provisional threshold or subthreshold depression using PHQ-9 scoring criteria, which were designed to yield provisional diagnostic information about major depressive disorder based on DSM-5 diagnostic criteria. RESULTS: Patients reporting higher severity of sleep problems on the PHQ-9 had significantly higher HbA1c levels (mean = 8.48, SD = 2.17) compared to patients reporting lower severity or absence of this symptom (mean = 7.19, SD = 1.34, t 48.88 = -3.13, P = .003). Problems with sleep contributed unique variance on glycemic control (β = 0.27, P = .02) when controlling for potential clinical and demographic covariates, with those reporting more sleep difficulties having higher HbA1c levels. CONCLUSIONS: For patients with type 2 diabetes and provisional threshold or subthreshold depression, it may be prudent to aggressively address sleep problems as a potential mechanism toward improving diabetes control.
OBJECTIVE: To determine whether specific depression symptoms are associated with glycemic control independent of potential demographic and clinical covariates among primary care patients with comorbid type 2 diabetes and provisional threshold or subthreshold depression. METHOD: We examined a convenience sample of patients diagnosed with type 2 diabetes and provisional threshold or subthreshold depression (N = 82) at 2 family health centers. Cases were identified using a population-based registry of patients diagnosed with type 2 diabetes (ICD-9 codes 250.00 for controlled type 2 diabetes and 250.02 for uncontrolled type 2 diabetes). Data from patients with a primary care provider appointment from the beginning of April 2011 through the end of June 2012 and with at least one 9-item Patient Health Questionnaire (PHQ-9) depression screener and a glycated hemoglobin A1c (HbA1c) laboratory test between 2 weeks before and 10 weeks after PHQ-9 screening were eligible for inclusion. We defined provisional threshold or subthreshold depression using PHQ-9 scoring criteria, which were designed to yield provisional diagnostic information about major depressive disorder based on DSM-5 diagnostic criteria. RESULTS:Patients reporting higher severity of sleep problems on the PHQ-9 had significantly higher HbA1c levels (mean = 8.48, SD = 2.17) compared to patients reporting lower severity or absence of this symptom (mean = 7.19, SD = 1.34, t 48.88 = -3.13, P = .003). Problems with sleep contributed unique variance on glycemic control (β = 0.27, P = .02) when controlling for potential clinical and demographic covariates, with those reporting more sleep difficulties having higher HbA1c levels. CONCLUSIONS: For patients with type 2 diabetes and provisional threshold or subthreshold depression, it may be prudent to aggressively address sleep problems as a potential mechanism toward improving diabetes control.
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