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Web-based Interventions May Assist Treatment of Diabetes Depression

Increased risk of depression may affect patient desire for face-to-face contact, hinder diabetes care…

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Many patients suffering from diabetes often suffer from depression, with statistics showing that these individuals have an increased risk of developing depression than an otherwise healthy individual. Depression can lead to worsening of diabetes and other poor health outcomes.  Web-based interventions might be beneficial in patients suffering from these comorbid conditions because they can log in whenever and wherever they need to, reducing the often undesired face-to-face contact. An international team of researchers from the Germany, the U.S., the Netherlands, and Denmark evaluated the efficacy of a guided web-based intervention in reducing depression in adults with type 1 and type 2 diabetes.

Data from 260 participants with diabetes and elevated depressive symptoms (Center for Epidemiologic Studies Depression Scale {CES-D ≥23]) was used. Half of the participants (n=130) were randomly assigned to the GET.ON Mood Enhancer Diabetes, which is a six session self-help guided intervention. The remaining half of the participants (n=130) were assigned to a brief online unguided psychoeducation program for depression.

The primary outcome of the study was depressive symptoms severity, and the secondary outcomes were diabetes-specific emotional distress and participant satisfaction. Data was collected at baseline and two months later. Differences in the outcomes between the two groups was determined using analyses of the covariance with the baseline CES-D score as covariate on both intent-to-treat (ITT) and per-protocol (PP) basis.

The ANCOVAs showed the GET. ON M.E.D. group reported significantly lower depressive symptoms as compared to the control group (F = 78.34; P <0.001). Furthermore, the individuals who suffered from major depressive disorder (MDD) were shown to benefit more than without MDD at baseline (F= 27.23; p <0.001;d = 0.74). The number of session attended was not significantly correlated with a reduction in depressive symptoms (r= -0.085; P =0.33). Significantly more participants of the intervention group (n=63) were below the value of 23 on the CES-D as compared to the control group (n=11). Lastly, the GET.ON M.E.D. intervention was effective in reducing diabetes-specific emotional distress, with a medium standardized effect size of d=0.58 (ITT).

Possible weaknesses of the trial include: over half of the patients suffering from MDD at baseline leading to more favorable results, mobile phone support may have added to efficacy, above average adherence during the study not being comparable to a clinical scenario.

The researchers concluded that web-based intervention was effective in decreasing depression in adults suffering from type 1 and type 2 diabetes by reducing both depressive symptoms and diabetes-specific emotional stress.

Practice Pearls:

  • Physicians should be aware of all treatment possibilities available to their patients, and should try their best to cater to their patient’s specific needs.
  • Web-based intervention may be a good option for patients who are embarrassed to speak with their clinician, who have limited time, or need constant reminders to stay on track.
  • Patients suffering from major depressive disorder may receive significant benefit from web-based intervention.

Nobis S. Efficacy of a Web-Based Intervention With Mobile Phone Support in Treating Depressive Symptoms in Adults With Type 1 and Type 2 Diabetes: A Randomized Controlled Trial. Diabetes Care. May 2015. 38(5)776-83