Association of depression with diabetes management among urban American indians/Alaska natives in the United States, 2011

Background: American Indians/Alaska Natives (AI/ANs) are more than twice as likely to have diabetes as non-Hispanic whites, and all individuals with diabetes are more likely to have depression. There is limited research on the association of depression with diabetes outcomes, particularly among urban AI/ANs. This analysis explores the relationship between depression and diabetes management among urban AI/ANs who received care at Urban Indian Health Organizations (UIHOs). Methods: Data were obtained from the Indian Health Service (IHS) Diabetes Care and Outcomes Audit performed at UIHOs. In 2011, 33 urban facilities participated; 3,741 patient records were audited. Primary exposure was depression as current medical problem. Outcomes included HbA1c, smoking, BMI, systolic blood pressure, creatinine, total cholesterol, and receipt of specific preventive services. Multivariate linear and logistic regression models assessed the relationship of depression with each outcome, using individuals with no depression as the reference group. Results: Individuals with depression and diabetes were 1.5 times more likely to smoke than individuals with diabetes but without depression (OR=1.51; 95% CI: 1.23, 1.86), controlling for age, sex, and facility. The geometric mean BMI in diabetes patients with depression was 3% higher than in patients without depression after adjustment (β=0.034; 95% CI, 0.011, 0.057). Conclusion: Urban AI/ANs with diabetes and depression are more likely to smoke and have higher BMI than those with diabetes but no depression. These findings contribute to the limited urban AI/AN-specific literature on this topic, and inform programmatic efforts to address the care and treatment of patients with both depression and diabetes.