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Cognitive Behavioral Therapy Versus Sertraline in Patients With Depression and Poorly Controlled Diabetes. The Diabetes and Depression (DAD) Study: A Randomized Controlled Multicenter Trial
Petrak, Frank; Herpertz, Stephan; Albus, Christian; u. a. (2015): Cognitive Behavioral Therapy Versus Sertraline in Patients With Depression and Poorly Controlled Diabetes. The Diabetes and Depression (DAD) Study: A Randomized Controlled Multicenter Trial, in: Diabetes care, Alexandria, Va., Jg. 38, Nr. 5, S. 767–775, doi: 10.2337/dc14-1599.
Faculty/Chair:
Title of the Journal:
Diabetes care
ISSN:
1935-5548
Corporate Body:
American Diabetes Association
Publisher Information:
Year of publication:
2015
Volume:
38
Issue:
5
Pages:
Language:
English
DOI:
Abstract:
OBJECTIVE
This study compared the long-term efficacy of a diabetes-specific cognitive behavioral
group therapy (CBT) with sertraline in patients with diabetes and depression
who initially responded to short-term depression treatment.
RESEARCH DESIGN AND METHODS
A randomized controlled single-blind trial was conducted in 70 secondary care
centers across Germany comparing 12 weeks of CBT with sertraline in 251 patients
with type 1 or 2 diabetes (mean HbA1c 9.3%, 78 mmol/mol) and major depression
(Structured Clinical Interview for DSM-IV [SCID]). After 12 weeks, treatment responders
(‡50% reduction Hamilton Depression Rating Scale [HAMD-17]) were
included in the 1-year study phase where CBT patients were encouraged to use
bibliotherapy and sertraline patients received continuous treatment. We analyzed
differences for HbA1c (primary outcome) and reduction (HAMD-17) or remission
(SCID) of depression from baseline to the 1-year follow-up using ANCOVA
or logistic regression analysis.
RESULTS
After 12 weeks, 45.8% of patients responded to antidepressant treatment and
were included in the 1-year study phase. Adjusted HbA1c mean score changes from
baseline to the end of the long-term phase (20.27, 95% CI 20.62 to 0.08) revealed
no significant difference between interventions. Depression improved in both
groups, with a significant advantage for sertraline (HAMD-17 change: 22.59,
95% CI 1.15–4.04, P < 0.05).
CONCLUSIONS
Depression improved under CBT and sertraline in patients with diabetes and depression,
with a significant advantage for sertraline, but glycemic control
remained unchanged. CBT and sertraline as single treatment are insufficient to treat secondary care diabetes patients with depression and poor glycemic control.
This study compared the long-term efficacy of a diabetes-specific cognitive behavioral
group therapy (CBT) with sertraline in patients with diabetes and depression
who initially responded to short-term depression treatment.
RESEARCH DESIGN AND METHODS
A randomized controlled single-blind trial was conducted in 70 secondary care
centers across Germany comparing 12 weeks of CBT with sertraline in 251 patients
with type 1 or 2 diabetes (mean HbA1c 9.3%, 78 mmol/mol) and major depression
(Structured Clinical Interview for DSM-IV [SCID]). After 12 weeks, treatment responders
(‡50% reduction Hamilton Depression Rating Scale [HAMD-17]) were
included in the 1-year study phase where CBT patients were encouraged to use
bibliotherapy and sertraline patients received continuous treatment. We analyzed
differences for HbA1c (primary outcome) and reduction (HAMD-17) or remission
(SCID) of depression from baseline to the 1-year follow-up using ANCOVA
or logistic regression analysis.
RESULTS
After 12 weeks, 45.8% of patients responded to antidepressant treatment and
were included in the 1-year study phase. Adjusted HbA1c mean score changes from
baseline to the end of the long-term phase (20.27, 95% CI 20.62 to 0.08) revealed
no significant difference between interventions. Depression improved in both
groups, with a significant advantage for sertraline (HAMD-17 change: 22.59,
95% CI 1.15–4.04, P < 0.05).
CONCLUSIONS
Depression improved under CBT and sertraline in patients with diabetes and depression,
with a significant advantage for sertraline, but glycemic control
remained unchanged. CBT and sertraline as single treatment are insufficient to treat secondary care diabetes patients with depression and poor glycemic control.
Peer Reviewed:
Yes:
International Distribution:
Yes:
Type:
Article
Activation date:
May 19, 2016
Permalink
https://fis.uni-bamberg.de/handle/uniba/40398