Depression, deficits in functional capacity, and impaired glycemic control in urban African Americans with type 2 diabetes

Abstract Background Effective depression treatment does not reliably reduce glycosylated hemoglobin (HbA1c) in depressed patients with type 2 diabetes, possibly in part due to deficits in functional capacity, i.e. performance of certain everyday living skills, essential for effective diabetes self-m...

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Published in:	Journal of psychiatric research Vol. 52; pp. 21 - 27
Main Authors:	Musselman, Dominique L, Ziemer, David C, McNutt, Marcia D, Seay, Julia S, Royster, Erica B, Larsen, Bridget, Barham, Terrika, Brown, Angelo R, Vogel, Octavia L, Phillips, Lawrence S, Harvey, Philip D
Format:	Journal Article
Language:	English
Published:	Kidlington Elsevier Ltd 01-05-2014 Elsevier
Subjects:	Activities of Daily Living Adjustment Adolescent Adult Adult and adolescent clinical studies African Americans Aged Aged, 80 and over Biological and medical sciences Black American people Blood Glucose - metabolism Depression Depression - epidemiology Diabetes Mellitus, Type 2 - blood Diabetes Mellitus, Type 2 - epidemiology Diabetes Mellitus, Type 2 - psychology Diabetes. Impaired glucose tolerance Endocrine pancreas. Apud cells (diseases) Endocrinopathies Etiopathogenesis. Screening. Investigations. Target tissue resistance Fasting - blood Female Functional capacity Functional status Glycaemic control Glycated Hemoglobin A - metabolism Glycemic control HbA1c Humans Longitudinal Studies Major depression Male Medical sciences Middle Aged MINI structured diagnostic interview Miscellaneous Mood disorders Neurocognition Psychiatry Psychology. Psychoanalysis. Psychiatry Psychopathology. Psychiatry Self Care Type 2 diabetes Type 2 diabetes mellitus UPSA-B Urban Population Young Adult Zung Depression Rating Scale Type 2 diabetes Glycemic control Major depression UPSA-B Zung Depression Rating Scale African Americans Neurocognition HbA1c MINI structured diagnostic interview Functional capacity Endocrinopathy Social environment Cognition Hemoglobin A1c Diagnosis Mood disorder Urban environment Evaluation scale Metabolic diseases Psychometrics Depression Ethnic group Directive interview Neuropsychologia African American
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Summary:	Abstract Background Effective depression treatment does not reliably reduce glycosylated hemoglobin (HbA1c) in depressed patients with type 2 diabetes, possibly in part due to deficits in functional capacity, i.e. performance of certain everyday living skills, essential for effective diabetes self-management. We sought to determine: a) the magnitude of deficits in functional capacity among urban, African American (AA) patients with type 2 diabetes, and b) whether these deficits were associated with poorer glycemic control. Methods At their initial visit to an inner-city diabetes clinic, 172 AA patients with type 2 diabetes were assessed with a variety of instruments, including the Mini International Neuropsychiatric Interview (MINI) and the UCSD Performance Skills Assessment-Brief (UPSA-B). They then entered a comprehensive diabetes management intervention, whose success was indexed by HbA1c levels at up to four reassessments over a one-year period. A mixed-effects model repeated-measures method was used to predict HbA1c. Results The prevalence of depression was 19%; the mean UPSA-B score was 81 ± 17. After multivariate adjustment, increased HbA1c levels over time were predicted by the presence of major depression ( B = .911, p = .002) and decreasing (worse) scores on the UPSA-B ( B = −.016, p = .027), respectively. Further adjustment for increasing the dosage of oral or insulin during the treatment eliminated the association between the UPSA score and HbA1c level ( B = −.010, p = .115). Conclusions Depression, as well as deficits in functional capacity, predicted reduced effectiveness of a diabetes self-management intervention. Future studies will determine whether interventions targeted at both improve glycemic control.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 ObjectType-Article-2 ObjectType-Feature-1
ISSN:	0022-3956 1879-1379
DOI:	10.1016/j.jpsychires.2014.01.006