Objectives: Assess whether adults with type 1 diabetes (T1D) with probable depression subsequently received pharmacological intervention for depression, and the impact of this intervention on glycemic control.
Research Design and Methods: Retrospective chart reviews were performed on adults ages 18-85 years, routinely screened for depression, with T1D of >1-year duration and no hemoglobinopathy, renal dysfunction (GFR <30), or dementia. Probable depression was defined by a score of ≥10 on the Patient Health Questionnaire (PHQ-9). Adults with probable depression at Time-1 were included if they had a follow-up PHQ-9 10-16 months later (Time-2) and a HbA1c within 1 month of completing each PHQ-9.
Results: The study included 93 participants (mean age=44 years, 55% female, 81% white, mean HbA1c 8.9%). At Time-1, 50 persons (53.8%) were prescribed anti-depressants. At Time-2, 5 additional persons (5.3%) received prescriptions. There were decreases in mean PHQ-9 scores (Time-1 15.99; Time-2= 4.55, p<.001) and HbA1c levels (Time-1= 9.3%; Time-2= 8.9%, p=.03). PHQ-9 scores related to HbA1c at each time point but did not relate to HbA1c change (p=0.48). There were marginally significant differences in PHQ-9 scores at Time-2 for those given anti-depressants (mean PHQ-9 = 5.75) versus those who were not (mean PHQ-9 = 2.82; p=.058), and a smaller decrease in HbA1c for those prescribed antidepressants (-.09) vs. those who were not (-.82; p= .042). Other interventions for depression (e.g., counseling) are not reliably captured in the EMR.
Conclusions: About 60% of adults with T1D and probable depression received anti-depressant medications. Despite an association between measures of depression and glycemic control, changes in each did not relate over 10-16 months. EMRs should improve documentation of therapeutic strategies to facilitate communication between providers working with depressed individuals and better inform future approaches to improve care.
B.J. Zaffuto: None. M. Greenfield: None. P.M. Trief: Research Support; Self; National Institute of Diabetes and Digestive and Kidney Diseases. C.P. Morley: None. R.S. Weinstock: Board Member; Self; JDRF. Consultant; Self; Insulogic LLC. Research Support; Self; Boehringer Ingelheim International GmbH, Diasome Pharmaceuticals, Inc., Eli Lilly and Company, Insulet Corporation, Jaeb Center for Health Research, Kowa Research Institute, Inc., Medtronic, Tolerion, Inc.
Type 1 Diabetes Exchange QI Learning Collaborative