May 28, 2019
2 min read

Behavioral therapy, exercise improves depression in type 2 diabetes

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A combination of cognitive behavioral therapy and consistent exercise can be used to effectively treat major depressive disorder and depressive symptoms in those with type 2 diabetes, even in rural and underserved areas, according to findings published in Diabetes Care.

“Patients with [type 2 diabetes] are two times more likely to experience depressive symptoms than their peers without diabetes,” Mary de Groot, PhD, associate professor of medicine at Indiana University School of Medicine in Indianapolis, and colleagues wrote. “In the general population, cognitive behavioral therapy and exercise have been widely demonstrated to be effective treatments for depression.”

De Groot and colleagues recruited 140 adults with type 2 diabetes and major depressive disorder, which was confirmed by a structured clinical interview, from Ohio, West Virginia and Indiana for a 12-week randomized controlled trial (Program ACTIVE II). According to the researchers, the study assessed the effects of cognitive behavioral therapy (CBT), exercise and a combination of the two treatments on depression, depressive symptoms and HbA1c levels. Participants (mean age, 56 years; 77% women; 71% white; 52% married) were randomly assigned into one of the three therapies or usual care.

Those in the CBT group addressed potentially depressive psychologic behaviors, which the researchers called “automatic thoughts,” during 10 visits with mental health care providers. In addition to six group exercise classes, those in the exercise group were asked to gradually build to and maintain 150 minutes per week of moderate activity. Those in the combination therapy group received both treatment plans.

Participants in the exercise group had the highest odds of major depressive disorder remission compared with those in usual care (OR = 6.78; 95% CI, 2.03-22.64), although those in the CBT group (OR = 5; 95% CI, 1.39-17.98) and the combination group (OR = 5.9; 95% CI, 1.69-20.58) also had better odds of remission than those receiving usual care. The researchers noted that the percentage of participants who experienced remission was more than twice as high for those in the exercise group (72%), the combination group (71%) and the CBT group (66%) compared with those in the usual care group (32%).

Based on Beck Depression Inventory scores, fewer depressive symptoms were reported by those in the CBT (P = .011), exercise (P < .001) and combination therapy (P = .021) groups compared with usual care. In addition, an improvement in diabetes-related quality of life was found for those in the exercise group (P =.001) and combination group (P < .001) compared with the usual care group, the researchers wrote.


Although the different therapy groups had seemingly positive effects on depressive symptoms and major depressive disorder, there was no significant effect on HbA1c. However, HbA1c decreased by 1.1% compared with the usual care group (P < .0001) for those in the combination therapy group who had an HbA1c of at least 7% before treatment, according to the researchers.

“Findings from this study demonstrate the effectiveness of individual and combined behavioral approaches on depression outcomes to treat depression tailored for adults with [type 2 diabetes],” the researchers wrote. “These findings suggest that these interventions can be adopted and used by a variety of behavioral health and exercise professionals to influence depression outcomes, including providers in regions with restricted access to specialist-level care resources.” – by Phil Neuffer

Disclosures: de Groot reports she is a faculty consultant to the LifeScan Diabetes Institute and Eli Lilly. Please see the study for all other authors’ relevant financial disclosures.