engleski

How adequate is the treatment for depression in diabetic patients?

Background and aimes: Depression is a prevalent co-morbid condition in diabetes. This study was aimed at determining the occurrence of depression in type 2 diabetic patients, as well as the degree to which depression was adequately treated. Materials and methods: A random sample of 405 type 2 diabetic outpatiens were screened for depression with the Center for Epidemiological Studies-Depression (CES-D) instrument. Patients with CES-D scores &#8805; 16 were invited for a psychiatric interview relying on Axis I disorders of the DSM-IV (SCID) to establish the clinical significance of their symptoms. Psychological anamnestic data and data on current life circumstances were collected by a semi-structured interview. Adequate treatment of depression was defined as the use of either an antidepressant or a mood stabilizer for a minimum of 30 days, or at least 8 outpatient visits with any professional qualified in psychotherapy. Results: Of the examined patients 24 % had CES-D scores&#8805; 16 (66% female, aged 57&plusmn ; 8 yrs, educated for 10&plusmn ; 3 yrs, having diabetes for 9&plusmn ; 6 yrs, treated with insulin in 44% of cases, with BMI 29&plusmn ; 4 kg/m&sup2 ; and HbA1c 7.9&plusmn ; 1.6%), and in 36% of them clinical depression was confirmed by SCID (64% female, aged 55&plusmn ; 8 yrs, with 10&plusmn ; 3 yrs of education, having diabetes for 9&plusmn ; 6 yrs, 43% insulin treated, with BMI 29&plusmn ; 4 kg/m&sup2 ; and HbA1c 7.9&plusmn ; 2.2%). When compared with subjects free of severe depressive symptoms (CES-D<16) and those with mild depression (CES-D>16 but not confirmed by diagnosis of depression), clinically depressed patients were found to be taking psychotropic medication in a significantly greater proportion (71% vs. 47% in the group with mild depression and 27% in the group free of severe depressive symptoms &#967; &sup2 ; =27.72 ; p<0.005). However, only 22% of patients with clinical diagnosis of depression were treated for depression in accordance with the established criteria, while the remaining majority was recommended drugs that could be not supposed to specifically relieve depressive symptoms. Thirty-two percent were without any treatment, among them one diagnosed with major depression during the screening procedure. Conclusions: The obtained data indicate that depression as a co-morbid condition in diabetes is neither sufficiently recognized nor specifically treated in the majority patients affected.

diabetes mellitus; depression; depression treatment

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