Program ACTIVE: Cognitive Behavioral Therapy to Treat Depression in Adults With Type 2 Diabetes in Rural Appalachia

Groot, Mary de; Doyle, Todd; Averyt, Jennifer

doi:10.1891/0889-8391.31.3.158

Cited by 7 publications

(5 citation statements)

References 27 publications

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“…While these studies highlight the importance of treating depression/psychological symptoms, it is also important to screen for these comorbidities. One study showed adults may not have received adequate treatment for depression, which in turn, may have affected the non‐pharmacologic and pharmacologic management of T2DM 59 . Additional studies are required to evaluate novel strategies to treat comorbidities and improve T2DM self‐management.…”

Section: Resultsmentioning

confidence: 99%

Burden and management of type 2 diabetes in rural United States

Dugani

Mielke

Vella

2020

Diabetes Metabolism Res

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In the United States, rural areas have a higher burden of type 2 diabetes (T2DM) compared to urban areas. However, there is limited information on risk factors and interventions that improve the primary prevention and management of T2DM in rural areas. To synthesize current knowledge on T2DM in rural areas and to guide healthcare providers and policy makers, we reviewed five scientific databases and the grey literature over the last decade (2010–2020). We described classification systems for rurality and the T2DM burden based on rurality and region (West, South, Midwest, and Northeast). We highlighted risk factors for T2DM in rural compared to urban areas, and summarized interventions to screen and manage T2DM based on opportunistic screening, T2DM self‐management, community‐based initiatives, as well as interventions targeting comorbidities and T2DM. Several studies identified the co‐existence of T2DM and depression/psychological symptoms, which could reduce adherence to non‐pharmacologic and pharmacologic management of T2DM. We highlighted the role of technology in education and counselling of patients with geographic and financial barriers to accessing care, which is exacerbated by the SARS‐CoV‐2 coronavirus disease‐19 pandemic. We identified knowledge gaps and next steps in improving T2DM care in rural areas. There is an urgent need for interventions tailored to rural areas given that rural Americans currently experience a disproportionate burden of T2DM and are encumbered by its associated morbidity, mortality, and loss in economic productivity.

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Section: Resultsmentioning

confidence: 99%

Burden and management of type 2 diabetes in rural United States

Dugani

Mielke

Vella

2020

Diabetes Metabolism Res

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“…Recent evidence from multiple clinical trials has demonstrated that the use of cognitive behavioral therapy (CBT) delivered through individual counseling or telephone-based therapy sessions is effective in improving depression outcomes. 21-24 A combination treatment of CBT counseling and antidepressant medications has shown effectiveness in depression outcomes. 25 The combination of CBT and community-based exercise interventions tailored for diabetes and delivered by community mental health and exercise professionals is the only modality that has shown effectiveness in improving both depression and A1C values.…”

Section: Psychosocial Considerations For People With Diabetesmentioning

confidence: 99%

A Practical Approach to Mental Health for the Diabetes Educator

Gonzalvo¹,

Hamm²,

Eaves³

et al. 2019

AADE in Practice

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In the United States, 17.9% of individuals are affected by mental illness. 1 Individuals with diabetes are at greater risk for depression and other psychosocial difficulties compared to the general population. Diabetes educators have identified depression, anxiety, diabetes distress, mild cognitive impairment, intellectual disabilities, maladaptive eating behaviors, dementia, and psychotic disorders as mental health conditions most commonly encountered in practice. 2 In a recent survey, most diabetes educators reported feeling somewhat comfortable knowing when to refer a person with diabetes to a mental health professional. 2 A general lack of mental health resources or access to mental health professionals were reported as struggles in the provision of care related to mental health for people with diabetes. 2 Referrals to a psychologist, social worker, or psychiatrist are common interventions for individuals with diabetes who are identified with mental health concerns. However, an appropriate referral does not end the interaction between diabetes educators and individuals identified with these difficulties. Diabetes educators need to be equipped with resources that complement the psychosocial management for people with diabetes. The objective of this paper is to provide diabetes educators with a practical guide to help support persons with or at risk for diabetes and concurrent psychosocial concerns. Psychosocial Considerations for People With Diabetes It is now well understood that the prevalence of comorbid mental health conditions is higher in people with diabetes than the general population. The most common conditions include depression, anxiety, disordered eating/eating disorders, and short-and long-term neurocognitive changes associated with hypo-and hyperglycemia 3 (Table 1).

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“…Sixty-seven percent of participants completed the intervention, which is comparable to the 67% to 80% completion rates reported in other studies of CBT depression interventions for adults with T2DM. 27,28 The completion rate for the mental health co-component of the intervention was 13% lower than that for participants in the Boot Camp alone, which was 80% during the study period. This suggests that persons with T2DM who are also experiencing moderate depression and/or anxiety may find it more challenging to successfully complete self-care programs, possibly due to the impact of their mental health status.…”

Section: Discussionmentioning

confidence: 90%

“…24 Cognitive behavioral therapy (CBT) is one of the most widely studied interventions for depression and anxiety, generally, 21,25 and has also been shown to be effective in the treatment of comorbid depression and anxiety in T2DM patients. 26-28 CBT is a structured and time-limited psychotherapy that emphasizes the relationships among cognitions, behaviors, and emotions. 29,30 CBT includes behavioral activation, cognitive restructuring, problem-solving, and relapse prevention.…”

mentioning

confidence: 99%

A Prospective, Non-randomized Feasibility and Preliminary Efficacy Study of a Telemedicine-Enabled Co-management Intervention for Adults With Type 2 Diabetes and Moderate Anxiety and/or Depression

Magee

Kaltman

Nassar

2021

The Science of Diabetes Self-Management and Care

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Purpose The primary aim of this pilot study was to examine the feasibility of codelivering a mental health intervention with an evidence-based type 2 diabetes (T2DM) boot camp care management program. The preliminary impact of participation on symptom scores for depression and anxiety and A1C was also examined. Methods This was a 12-week, non-randomized pilot intervention conducted with a convenience sample of adults with uncontrolled T2DM and moderate depression and/or anxiety at an urban teaching hospital. Co-management intervention delivery was via in-person and telehealth visits. Participants were assessed at baseline and 90 days. Results Participants (n = 18) were African American, majority female (83%), and age 50.7 ± 13.4 years. Significant improvements in mental health outcomes were demonstrated, as measured by a reduction in Patient Health Questionnaire − 9 scores of 2.4 ± 2.9 ( P = .01) and in Generalized Anxiety Disorder − 7 scores of 2.3 ± 1.9 ( P = .001). The pre-post intervention mean A1C improved by 3.4 ± 2.1 units from 12% ± 1.4% to 8.5% ± 1.7% ( P < .001). Conclusion The data generated in this pilot support the feasibility of delivering a diabetes and mental health co-management intervention using a combination of in-person and telemedicine visits to engage adults with T2DM and coexisting moderate depression and/or anxiety. Further research is warranted.

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Program ACTIVE: Cognitive Behavioral Therapy to Treat Depression in Adults With Type 2 Diabetes in Rural Appalachia

Cited by 7 publications

References 27 publications

Burden and management of type 2 diabetes in rural United States

Burden and management of type 2 diabetes in rural United States

A Practical Approach to Mental Health for the Diabetes Educator

A Prospective, Non-randomized Feasibility and Preliminary Efficacy Study of a Telemedicine-Enabled Co-management Intervention for Adults With Type 2 Diabetes and Moderate Anxiety and/or Depression

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