Diabetes Management: Telephonic CBT Counseling for Diabetics with Depression Can Improve Treatment Outcomes

A NEW investigative study by researchers at VA Ann Arbor Healthcare System and University of Michigan Health System shows that telephonic intervention can improve patients’ access to effective depression care, improve their cardiovascular health and get them moving again, reports Endocrine Web.

As is well known, depression is a common, treatable issue for many people who have diabetes but most busy clinics cannot provide the level of intensive care these patients need. In many cases this proves to be a major hurdle for diabetics in maintaining the strict medication regimen or exercise schedule.

Patients with diabetes and depression often have self-management needs that require between-visit support. The study evaluated the impact of telephone-delivered cognitive behavioral therapy (CBT) targeting patients’ management of depressive symptoms, physical activity levels, and diabetes-related outcomes.

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The research team worked over a year to improve diabetes patients’ health by first addressing their depression. The program began with behavioral therapy sessions over the telephone with a specially trained nurse and later phased in a walking program. This was done because delivering therapy by telephone makes it feasible to reach large numbers of patients who may not attend traditional in-person appointments.

For the investigation, researchers divided a group of 291 participants with type 2 diabetes and significant depressive symptoms into two groups. One group received standard care, while the other segment was put through a year-long intervention program, which consisted of 12 weeks of cognitive behavioral therapy and nine months of supplemental phone checkups.

The findings ‒ published online ahead of print in Medical Care ‒ showed the intervention was successful in lowering patients’ blood pressure, increasing their physical activity by about four miles of walking per week and easing their depressive symptoms. At the end of the year, 58 percent of patients who received the intervention had depression symptoms that were in remission, compared to only 39 percent of the patients who did not receive counseling.

Even Telephonic Intervention Improves Diabetes Control

The cognitive behavior therapy helped the study participants address negative thought processes and behaviors that made it difficult for them to manage their diabetes and make healthy lifestyle choices.

The physical activity component of the program used pedometers to help patients set walking goals and monitor their progress. Earlier studies have shown that along with physical benefits, exercise also helps boost one’s mood.

Indeed, patients with depression and additional chronic medical conditions do better, as the study demonstrates, if their depression is addressed first, if it is addressed systematically, and if exercise is also encouraged.

Most patients entered the study with relatively good blood glucose control. So while the intervention did not lead to a drop in A1C ‒ a common measurement of blood glucose levels ‒ patients did see more than a 4-point improvement in their systolic blood pressure, walked about half a mile more per day and reported an improvement in their general quality of life.

“This study shows that telephone-delivered counseling can improve patients’ access to effective depression care, improve their cardiovascular health and get them moving again,” said lead author John Piette.

In view of this study, “health systems should consider routinely offering structured telephone psychotherapy to their patients with diabetes and depression,” concluded senior study author Marcia Valenstein.

(The research was funded by grants from the National Institutes of Health, Michigan Diabetes Research and Training Center and the Michigan Institute for Clinical and Health Research.)

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