7%). The study actively scheduled Individual Education arm subjects (n=245) for three 1-hour diabetes education sessions at the ADA-accredited care systems: Subjects in the control group (n=134) were passively followed. Baseline depression was assessed using the PHQ-9 scale. A1c declined from 8.32% at baseline to 7.71% at 6 months in the Individual Education arm (p<0.001; intention-to-treat analysis). This reduction was 0.27% greater in the active, Individual Education arm than in the control group (p=0.02), and 0.51% greater when restricted to subjects with baseline A1c >8%, (p=0.04). Baseline A1c was higher in subjects having higher PHQ-9 scores: Mean A1c measures for subjects with PHQ-9 scores of 0-4 (not depressed), 5-9 (mild depression), and 10+ (moderate depression or greater) were 8.1%, 8.2%, and 8.7% (linear trend p=0.02). Corresponding completion rates were 92.2, 85.9, and 71.7% (p-dif=0.001). In summary, Individual Education led to modestly improved A1c, and improvement was greater in subjects with higher baseline A1c. Subjects with moderate or greater depression had higher baseline A1c and therefore stood to benefit more from DMSE, but were less likely to complete the sessions. Results suggest that educators consider depression screening to identify patients who may be less likely to adhere to recommended DSME visits. Further analysis will evaluate whether DMSE results in improved glycemic control in patients with depression, and if not, whether lack of improvement is explained by non-adherence (non-completion of sessions).
Depression is common in diabetes, and evidence indicates that depressed patients are less adherent to self-care behaviors. It is unclear how depression affects diabetes patients’ completion of Self Management Education (DMSE) programs, and whether patients with depression benefit as much from DMSE. We evaluated DMSE completion in a randomized trial (Journey for Control of Diabetes IDEA) of diabetes education in patients with sub-optimally controlled type 2 diabetes (A1c