Treating major depression in type 2 diabetes

One of our highlights from the 77th Scientific Sessions of the ADA. 

by Prof Jane Speight

On the final day of the American Diabetes Association conference, the highest scoring abstracts are presented in the prestigious ‘President’s Orals’ session.

Among those selected was ‘Program ACTIVE II’, presented by clinical health psychologist, Dr Mary de Groot (Indiana University, USA). This was a comparative effectiveness trial of three interventions to treat major depression disorder in adults with type 2 diabetes. Participants were randomised to: a) 10 individual sessions of cognitive behavioural therapy (CBT), b) 12 weeks of community-based exercise (EXER), c) CBT+EXER (concurrent interventions over 12 weeks), or d) usual care. Compared to usual care, Dr de Groot and colleagues found that participants in all three intervention groups (CBT, EXER and CBT+EXER) reported fewer depressive symptoms and reduced diabetes-specific distress. Those with an exercise component (EXER or CBT+EXER) also reported improve diabetes-specific quality of life. Those in the CBT groups had 12.6 times the odds of full or partial remission of major depressive disorder compared with the usual care group, while those in the EXER groups had 5.8 times the odds. In those with a baseline HbA1c of at least 7.0%, EXER resulted in a clinically meaningful 0.7% improvement in HbA1c, compared with those receiving CBT or usual care. This impressive study has demonstrated clinically meaningful improvements in major depressive disorder, diabetes distress and glycaemic outcomes in adults with type 2 diabetes. The authors concluded that this evidence enables psychological and exercise therapy to be offered to those adults with type 2 diabetes experiencing major depression.

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