https://diabetes.acponline.org/archives/2014/09/12/5.htm

In uncontrolled type 2 diabetes, CBT improved glycemic control and reduced depression

Patients with diabetes and depression who received cognitive behavioral therapy (CBT) had improvements in medication adherence, self-monitoring of glucose, depressive symptoms, and HbA1c compared to those who received usual care.


Patients with diabetes and depression who received cognitive behavioral therapy (CBT) had improvements in medication adherence, self-monitoring of glucose, depressive symptoms, and HbA1c compared to those who received usual care. All 87 patients received consultations with a diabetes educator and dietitian and 1 CBT session, but those who were randomized to between 8 and 10 additional sessions of CBT had a mean HbA1c of 7.9% after 4 months compared to 8.6% in the non-CBT group.

The study was published in Diabetes Care in March. The following commentary by David L. Bronson, MD, MACP, and Kathleen S. Franco, MD, FACP, was published in the ACP Journal Club section of the Aug. 19 Annals of Internal Medicine.

CBT is useful for patients with chronic diseases who have comorbid psychiatric disorders, difficulty adjusting to illness, or suboptimal compliance with treatment regimens. Safren and colleagues developed an integrated CBT intervention tailored for patients with suboptimally controlled type 2 diabetes and mild to moderate depression. This is an important group of patients given the increased risk for depression in type 2 diabetes and the negative effect of depression on diabetes treatment adherence and glycemic control. Surprisingly, the study did not report adherence to, or new prescriptions for, antidepressants during the trial, which may have had an effect on depression outcomes.

The trial results support using CBT in this common clinical setting. However, one cannot discern whether any face-to-face intervention that added 9 to 12 visits over 4 months would have yielded similar outcomes for adherence and diabetes control.

Although the results are promising, the availability of skilled therapists and time during typical diabetes management clinical encounters are both limited, which makes including CBT by primary providers less feasible. Use of Web-based, self-paced CBT is a promising approach for treating depression and diabetes-related emotional distress in patients with type 1 and type 2 diabetes. However, withdrawal rates are high and access may be limited for disadvantaged minorities as well as patients who are elderly, have lower incomes, or are less educated.