Diabetes requires constant self-care, which may lead to chronic stress and depression for some patients. Behavior therapy may lead to better self-care, ease depression and improve blood sugar control.
New research shows that cognitive behavioral therapy may help diabetes patients handle their self-care and depressive symptoms.
Cognitive behavioral therapy is a form of treatment that focuses on assessing the relationships between thoughts, feelings and behavior.
Steven Safren, PhD, director of Behavioral Medicine in the Department of Psychiatry at Massachusetts General Hospital in Boston, along with fellow scientists, observed 87 patients who had uncontrolled type 2 diabetes and depression.
Past studies have found that 15 to 20 percent of diabetes patients deal with major depression.
Dr. Safren told dailyRx News, “Having depression can make it much harder for someone to adhere to a complicated self-care regimen required in diabetes. Therefore, having an intervention that can help with both depression and adherence, which leads to better diabetes control, is of high importance.”
All patients in this study were receiving Enhanced Treatment as Usual (ETAU). With this course of therapy, patients met once with a nurse educator to set goals for self-monitoring blood sugar, twice with a dietitian to set individualized diet and physical activity goals and once with an adherence counselor to help with these self-management goals.
The researchers wanted to compare ETAU with a more intensive approach called cognitive behavioral therapy for adherence and depression (CBT-AD). They divided patients into two groups: one getting only ETAU and one receiving ETAU plus CBT-AD.
Whereas the ETAU patients had one session designed to improve adherence to medical recommendations and individualized diabetes self-management goals, the CBT-AD patients participated in that same intervention plus nine to 12 sessions designed to improve behaviors.
These CBT-AD “modules” included introducing the patient to the nature of cognitive behavioral therapy and motivational interviewing for behavior change; increasing pleasurable activities and mood monitoring; thought monitoring and cognitive restructuring (adaptive thinking); problem-solving as a skill to aid in decision-making processes, particularly those related to diabetes self-care; and relaxation training.
“CBT is a form of talk therapy and is a well-studied, effective treatment for depression,” Dr. Safren told dailyRx News.
“The cognitive part involves helping people with depression think more adaptively about situations in their lives and gain a realistic perspective on them. The behavioral part involves making sure that people with depression are putting themselves in situations and activities that may maximize enjoyment and therefore affect mood. Additionally, it involves helping people solve problems through a specific process of breaking down problems into manageable steps and selecting the best solution,” said Dr. Safren.
After four months of treatment, the CBT group, compared to the other group, had about 21 percent greater oral medication adherence on electronic pill cap (a bottle that activates a signal notifying a patient it’s time to take medication).
The CBT patients also had 30 percent greater self-monitoring of blood sugar adherence and 6.44 points lower score on a depression scale.
The CBT-AD individuals also lowered their A1C blood sugar level by 0.72 units on average compared to ETAU patients.
The authors wrote that analyses at 4, 8 and 12-months of follow-up showed that the CBT-AD group maintained 24 percentage points higher medication adherence, 17 percentage points greater SMBG adherence and 0.63 units lower A1C after acute treatment ended.
“CBT-AD is an effective intervention for adherence, depression and [blood sugar] control, with enduring and clinically meaningful benefits for diabetes self-management and glycemic control, in adults with type-2 diabetes and depression,” the authors wrote.
Dr. Safren offered this advice to dailyRx News readers: “If you feel that you are experiencing symptoms of depression, including but not limited to things like sadness, loss of interest and sleep problems, talk about it with your doctor because effective treatments are available.”
This study was published online on October 29 in Diabetes Care. This research was supported by a grant from the National Institute of Mental Health.