OBJECTIVETo compare whether depressive symptoms are more strongly related to subsequent or prior glycemic control in type 2 diabetes and to test whether patient characteristics modify these longitudinal associations.RESEARCH DESIGN AND METHODSOn two occasions separated by 6 months, depressive symptoms and glycemic control were assessed in 253 adults with type 2 diabetes. Regression analyses examined depressive symptoms as both a predictor and outcome of glycemic control and tested whether medication regimen (e.g., insulin versus oral drugs) was an effect modifier before and after adjusting for baseline levels of the outcome being predicted.RESULTSDepressive symptom severity predicted poor glycemic control 6 months later (P = 0.018) but not after baseline glycemic control was taken into account (P = 0.361). Although baseline glycemic control did not generally predict depressive symptoms 6 months later (P = 0.558), it significantly interacted with regimen (P = 0.008). Specifically, glycemic control predicted depressive symptoms among patients prescribed insulin (β = 0.31, P = 0.002) but not among those prescribed oral medication alone (β = −0.10, P = 0.210). Classifying depression dichotomously produced similar but weaker findings.CONCLUSIONSDepressive symptoms do not necessarily lead to worsened glycemic control. In contrast, insulin-treated patients in poor glycemic control are at moderate risk for worsening of depressive symptoms. These patients should be carefully monitored to determine whether depression treatment should be initiated or intensified.

The generally weak association between depression and glycaemic control is concentrated among patients who are prescribed insulin. Similarly, the association between depression and illness quality of life is strongest in patients prescribed insulin. Because this is not attributable to depression-related adherence problems, psychophysiological mechanisms unique to this group ought to be carefully investigated. Clinicians might be especially vigilant for depression in Type 2 DM patients who use insulin and consider its potential impact upon their illness course.

Objective To compare rates of discussion and treatment for depression among African Americans and Whites with diabetes. Methods Measures of diabetes status, depressive symptoms, and history of discussing and being treated for depression were collected from 56 adults with depressive symptoms accompanying diabetes who were drawn from a larger study of type 2 diabetes. Results Analyses adjusted for confounders and multiple tests indicated that relative to Whites, African Americans were 6–12 times less likely to have ever: discussed depression with anyone (p=.007), discussed depression with their primary care physician (p=.008), been prescribed an antidepressant (p=.002), and they were 25 times less likely to have seen a psychiatrist (p=.003). There were no significant differences in discussing depression with clergypersons, or family members/friends. Conclusions Compared to their White counterparts, African Americans with depressive symptoms accompanying diabetes are unlikely to discuss depression with healthcare professionals, be prescribed antidepressant medication, or be seen by a psychiatrist. Minority diabetes patients' medical and psychiatric outcomes may improve if healthcare providers more actively initiate these discussions, provide culturally-tailored education about the nature of depression and its management, incorporate patient preferences into treatment plans, and establish relationships with persons more likely to learn about African American patient symptoms.

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