Posted Mar 14 , 2017 02:20 PM

Tangled up in Blue: Unraveling the Links Between Emotional Distress and Treatment Adherence in Type 2 Diabetes

Gonzalez JS, et al. Diabetes Care 2016 Online October 17

What were the findings (Excerpted form the Abstract)?

This study was conducted using comprehensive assessments of emotional distress to examine the relationship between emotional distress and diabetes medication adherence over time. The authors selected ethnically and socioeconomically diverse adults treated for type 2 diabetes, and they were asked to complete validated self-reports (SRs) for diabetes distress and depression. They were also administered semi-structured depression interviews, and blood samples were collected for A1C. Medication adherence among 104 participants was electronically monitored (EM) over the subsequent 3 months; validated SRs of medication adherence were also obtained. Linear regression was used to evaluate independent effects of diabetes distress and depression on adherence. Mean 6 month medication adherence was 76.1% for EM and 83.7% for SR. Regression models showed baseline diabetes distress was a significant independent predictor of EM and SR at follow-up. SR depression was an independent predictor of EM and SR adherence and reduced the effects of diabetes distress to non-significance. Subsequent models indicated this effect was driven by somatic rather than cognitive-affective symptoms of depression. Diabetes distress and depression shared between 20% and 38% of their variance in this sample, suggesting substantial overlap in the measurement of these emotional distress constructs.

Why is this important?

This study supports the notion that diabetes-related distress and depression symptom severity are risk factors for type 2 diabetes medication non-adherence. Somatic symptoms captured by depression measures, but not cognitive-affective symptoms, independently predicted non-adherence and should be further investigated as a potential link between emotional distress and non-adherence. The findings from this study demonstrate an independent role for somatic symptoms in medication non-adherence. The PHQ-9 assesses four somatic (sleep, fatigue, appetite, and psychomotor retardation) and five cognitive-affective symptoms (lack of interest, depressed mood, negative self-feelings, concentration problems, and suicidal ideation) and has been recommended as an important tool in assessing somatic symptoms, and a useful addition to the management of people with diabetes. Are you screening your patients for depression using the PHQ-9? Have you seen a relationship between their scores and medication adherence?

Read the Abstract: