173804 Depression, diabetes, & glycemic control The Strong Heart Family Study

Tuesday, October 28, 2008

Darren Calhoun, PhD , Strong Heart Study - Phoenix Field Office, Medstar Research Institute, Phoenix, AZ
Janette Beals, PhD , American Indian and Alaska Native Programs, University of Colorado at Denver Health Sciences Center, Aurora, CO
Elizabeth A. Carter, MPH , Department of Biostatistics, Epidemiology, Outcomes and Data Management, Medstar Research Institute, Hyattsville, MD
Thomas Welty, MD, MPH , Cameroon Baptist Convention Health Board, Bamenda, Cameroon
Elisa Lee, PhD , Director, Center for American Indian Health Research, University of Oklahoma Health Sciences Center, Oklahoma City, OK
Barbara V. Howard, PhD , Senior Scientist, Medstar Research Institute, Hyattsville, MD
The Strong Heart Family Study is a longitudinal study of cardiovascular disease (CVD) and its risk factors in American Indians. This analysis focused on the association of depression score with diabetes (DM) a major CVD risk factor, among 2846 participants 14 years of age and older. DM was assessed using ADA criteria and depression score using the CES-D (self-reported depression) score. Thirty-four percent of participants with DM had possible depression (score > 16) compared to 28% of those without DM (p<0.01). The differences were greater in older participants.

Prevalence of Depression

AGE DM No DM p-value*

14-30 19 (40%) 288 (33%) 0.303

31-50 100 (36%) 237 (29%) 0.028

51+ 111 (34%) 86 (24%) 0.003

*Chi-square tests were used to test for differences in proportions.

Among participants with DM, the mean HbA1c levels in those with and without depression did not differ significantly but the mean HbA1c levels in the lowest and highest quartiles of CES-D score were significantly different (8.03% vs. 8.60%; p<0.02). In a multiple linear regression model adjusted for age, BMI, and other variables that excluded newly diagnosed cases (N=91), HbA1c was significantly related to CES-D in participants with diagnosed DM (p<0.05). However, for every 1-unit increase in the CES-D score, HbA1c increased by only 0.021%.

These finding suggest higher rates of depression among those with DM, particularly among older adults. The severity of depression score was associated with glycemic control among those with known DM.

Learning Objectives:
1. Recognize the increased risk of co-morbid depression and diabetes in older patients. 2. Discuss the importance of screening for depression in routine DM care. 3. Prioritize the need to treat DM and depression simultaneously to achieve improved outcomes.

Keywords: Depression, Diabetes

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have a PhD in clinical psychology from the University of Montana. I have more than 8 years experience in the area of care delivery to patients with diabetes and depression. Additionally, I have been involved in multiple research studies in the past 8 years focusing on the topics of diabetes and depression. I have presented/lectured at many regional meetings on the topics of diabetes and depression to audiences consisting of a wide variety of research and clinical health care professionals.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.