December 28, 2018
2 min read

Depressive symptoms may interfere with diabetes medication adherence in adults with elevated HbA1c

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Among adults with type 2 diabetes and poor glycemic control, not taking medication as recommended may be linked to depressive symptoms, according to findings published in the Journal of Diabetes and its Complications.

Claire J. Hoogendoorn

“Our results highlight the complex relationship between depressive symptoms and medication nonadherence,” Claire J. Hoogendoorn, PhD, research associate and adjunct assistant professor at Yeshiva University in New York, told Endocrine Today. “Continued research involving symptom-level associations may help clarify mixed findings in terms of depressive symptoms and self-management behaviors among individuals with diabetes and may contribute to the development of interventions that improve emotional distress and health behaviors concurrently.”

Hoogendoorn and colleagues used data from a subset of participants in a randomized controlled trial with members of a union/employer-sponsored health plan in New York City. Participants were recruited for the initial trial via telephone. All participants (n = 376; mean age, 56.6 years; 68.6% women) were aged at least 30 years, were taking at least one oral diabetes medication and had suboptimal glycemic control, defined as HbA1c of at least 7.5%.

The researchers assessed somatic and cognitive affective depressive symptoms based on the Patient Health Questionnaire-8, which uses a 4-point scale. Participants reported symptom frequency on a scale of 0 to 3, with 0 being not all and 3 being nearly every day. Symptoms included having trouble falling and staying asleep, being tired or having little energy, having poor appetite, moving or speaking slowly (somatic) and taking little pleasure in doing things, feeling down, feeling bad about yourself and having trouble concentrating (cognitive affective). A total score of 10 or more equated to a positive screening for a major depressive disorder.

Medication adherence was determined by participant self-report through the 4-item Morisky Green Levine Medication Adherence Scale and pharmacy claims obtained from the health care worker union fund. Glycemic control was determined by HbA1c, with participants using mail-in kits to provide measurements. In the entire cohort, low adherence was associated with an HbA1c level of 8.5% or greater (P = .048).

The average score on the depressive symptoms questionnaire was 5.5, which the researchers said indicated mild depression. In addition, 23% of the participants had a positive screening for a major depressive disorder based on the questionnaire, according to researchers.

The researchers determined that 207 participants had low medication adherence. Low medication adherence was associated with a questionnaire score greater than 10 (P < .001) as well as all four cognitive affective symptoms (P = .002) and two of four somatic symptoms, specifically being tired or having little energy (P = .049) and moving or speaking slowly (P = .011). According to the researchers, odds of low adherence increased 2.72-fold when a positive screening for a major depressive disorder was present (OR = 2.72; 95% CI, 1.56-4.73). Only the somatic symptom of being tired or having little energy retained its status as an independent predictor of low adherence even when excluding likely depression (OR = 1.77; 95% CI, 1.09-2.87) and when adjusting for a positive depression screen (OR = 1.71; 95% CI, 1.06-2.77).

“This study supports that the presence of clinical levels of depressive symptoms, as well as fatigue independent of depression, may be risk factors for low medication adherence,” Hoogendoorn said. “However, given the cross-sectional nature of the results, as well as the lack of consistency among studies, it is difficult to make specific clinical recommendations until the relationship between depressive symptoms and medication adherence is further clarified.” – by Phil Neuffer

For more information:

Claire J. Hoogendoorn, PhD , can be reached at the Ferkauf Graduate School of Psychology, Yeshiva University, 1165 Morris Park Ave., Bronx, NY 10461; email:

Disclosures: The authors report no relevant financial disclosures.