Background and aims: Subthreshold depression is one of the most frequent mental comorbidities in people with diabetes and is associated with a poorer long-term prognosis. Since specific intervention concepts are missing a new self-management oriented group programme (DIAMOS) was developed for this patient group and evaluated in a randomised trial.
Materials and methods: The active control group (CG) received diabetes education. DIAMOS consisted of cognitive behavioural interventions aiming at the reduction of diabetes distress. Patients completed several questionnaires at baseline and follow-up: The Center of Epidemiological Studies-Depression Scale (CES-D), the Patient Health Questionnaire (PHQ 9), the Problem Areas in Diabetes Questionnaire (PAID) and the Diabetes Distress Scale (DDS). Primary outcome was the reduction of depressive symptoms. Secondary outcomes were diabetes distress, well-being, self-care behaviour, diabetes acceptance, diabetes treatment satisfaction, HbA1c and inflammatory markers. 214 participants were randomised.
Results: Baseline characteristics (age 43.3 ±13.3 yrs., female gender 56.5%, diabetes duration 14.2 ±10.5 yrs., type 2 diabetes 34.1%, BMI 28.7 ±71 kg/m²) were comparable between both interventions groups except BMI and diabetes type. At 12-month follow-up there was a significant greater reduction of the CESD- and PHQ 9-scores in DIAMOS compared to the CG (Δ -3.7, 95%-CI 0.57 to 6.85 p=.021 respectively Δ -1.49, 95%-CI 0.08 to 2.90; p=.039). The risk of incident major depression was reduced (OR 0.63, 95%-CI 0.42 to 0.96, p=.028) Also PAID-scores (Δ -8.3 95%-CI 3.33 to 12.72, p=.001) and DDS-scores (Δ -0.22 95%-CI 0.02 to 0.42, p=.042) were significantly reduced. C-reactive protein was significantly more lowered (Δ -0.25 95%-CI 0.02 to0.48 p=.035). No effect of the intervention was observed in other inflammatory markers (IL1RA, IL6 and adiponectin).
Conclusion: DIAMOS is more effective in lowering depressive symptomsand diabetes related distress in diabetic patients with subthreshold depression. DIAMOS also has a preventive effect regarding the incidence of major depression.