Reports in the literature of the association of depression and glucose control are inconsistent. The relationship between depression and attitudes toward diabetes, self-efficacy, self-care adherence and A1c is of interest.
As part of the Journey for Control of Diabetes IDEA Study , 623 consented subjects with pre-existing type 2 diabetes and A1c>=7% at sites in New Mexico (LCF Research) and Minnesota (HealthPartners Research Foundation) were randomized to group or individual education or to usual care (no education). At the baseline visit, patients completed a survey that included a PHQ9 screening for depression, the Diabetes Empowerment Scale and Diabetes Care Profile for positive and negative attitudes and self-care adherence. Severity of depression was categorized by PHQ9 score and frequencies calculated overall and by gender. Correlations were obtained between depression scores and attitudes, self-efficacy, self-care adherence and A1c and were stratified by gender, age (<65 or > 65) and income (<$50000 or > $50000).
53.1% of subjects had no depression (55%F, 59.7%M), 26.7% had mild depression (24.5%F, 24.2%M), 13.3% had moderate depression (12.6%F, 10.8%M) and 6.9% had moderately severe to severe depression (8%F, 5.4%M). Correlations showed moderate relationships between PHQ9 score and attitudes (positive,-0.53,p<0.0001 and negative, 0.46,p<0.0001), self-efficacy (-0.33,p<0.0001) and self-care adherence (-0.42,p<0.0001). Correlation to A1c was 0.2 (p<0.0001) overall, 0.26 (p<0.0001) for men and 0.15 (p=0.0079) for women. The gender, age and income stratifications did not show pronounced differences in other PHQ9 correlations.
Depressive symptoms occur in about half of enrolled subjects with suboptimally controlled diabetes, occur more frequently in women and correlate modestly in both genders with attitudes, self-efficacy, self-care adherence and less so with A1c. In a cross-sectional analysis, depression is more highly correlated with A1c in males than females without major differences noted in age or income categories. More research is needed to study the relationship between gender, depression and glycemic control.