Diabetes Self-Management Education: Impact on depression in the elder with diabetes

Diabetes is an epidemic, partly driven by the increase of elders in the population. Those with diabetes have a two-fold increase in the incidence of depression, and those with depression have twice the risk of developing diabetes. Elderly persons with depression are often underdiagnosed and undertreated for this disabling combination. Many psychotropic drugs not only worsen glycemic control, but impair cognition through anticholinergic effects. The elderly are particularly stigmatized by a depression diagnosis and in many cases can least afford the expense of pharmacological treatment. Diabetes self-management education (DSME) is the cornerstone of diabetes care, teaching self-care behaviors and stressing empowerment. It is similar to cognitive behavioral therapy, which has been shown to be an effective treatment for depression in those with diabetes. The purpose of this study is to determine if those who have learned and practice diabetes self-care behaviors will have a lower incidence of depression than those who do not. Community-dwelling elders with diabetes are being surveyed with an instrument (the DD-S) designed by the author and pilot tested during the initial phase of this study. The DD-S tool screens for depression and measures self-care behaviors. A self-administered depression instrument (the CES-D) is also included as part of this mail-based survey, which is in progress. Over 2000 surveys have been distributed to elders with diabetes to compare those with diabetes who have attended education and practice self-care and those who have not. Survey results will be shared during the meeting.