Cognitive behavioral therapy improved treatment adherence, HbA1c in diabetes, depression

Safren SA. Diabetes Care. 2014;doi:10.2337/dc13-0816.

  • March 13, 2014

Immediately after treatment with specialized cognitive behavioral therapy, patients with type 2 diabetes and depression showed greater medication adherence and a higher level of blood glucose control, and the improvements were maintained for 12 months.

In a study conducted at Massachusetts General Hospital, researchers enrolled 87 adults with poorly controlled type 2 diabetes who also met the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria for unipolar depression. All participants received enhanced treatment for medication adherence, self-monitoring blood glucose and lifestyle counseling. After initial treatment, 45 participants were randomly assigned to an intervention consisting of nine to 11 sessions of cognitive behavioral therapy for adherence and depression (CBT-AD).

Four months after treatment, patients in the CBT-AD arm showed 20.7% greater adherence to oral medication (95% CI, –31.14 to –10.22) based on data collected by electronic pill bottle caps. The group assigned to CBT-AD also showed 30.2% greater SMBG adherence (95% CI, –42.95 to –17.37) and, on average, scored 6.44 points lower on the Montgomery-Asberg Depression Rating Scale (95% CI, 2.33-10.56), 0.74 points lower on the Clinical Global Impression scale (95% CI, 0.16-1.32), and had 0.72 lower HbA1c units (95% CI, 0.29-1.15) than those in the enhanced treatment as usual group.

Steven Safren, Ph.D., ABPP

Steven Safren

Treatment follow-up at 4-, 8- and 12-month intervals showed that the group assigned to CBT-AD maintained 24.3% higher adherence to medication (95% CI, –38.2 to –10.3), 16.9% higher adherence to SMBG (95% CI, –33.3 to –0.5) and 0.63 units lower HbA1c (95% CI, 0.06-1.2) at the end of treatment. Minor evidence for improvement of depression was reported, but without a significant difference between the two groups.

"The association between depression and type 2 diabetes is well-documented, but clinical trials of either medication or psychological treatment for depression have had mixed or negative effects on adherence to treatment programs," Steven Safren PhD, ABPP, director of behavioral medicine, department of psychiatry at Massachusetts General Hospital, said in a press release. “In this study, we adapted our approach that has improved treatment adherence among HIV/AIDS patients by addressing both depression and treatment self-management skills.” 

Disclosure: The researchers report no relevant financial disclosures.

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