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Published by: Maria Kristina Jezelle Abuan on Dec 18, 2012
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The Prevalence of Comorbid Depression in Adults With Diabetes A meta-analysis1.
, 3.
 Author Affiliations
Psychiatry and2.
Medicine, Washington University School of Medicine3.
Department of Veterans Affairs Medical Center, St. Louis, Missouri
To estimate the odds and prevalence of clinically relevant depression in adults with type 1or type 2 diabetes. Depression is associated with hyperglycemia and an increased risk for diabeticcomplications; relief of depression is associated with improved glycemic control. A more accurateestimate of depression prevalence than what is currently available is needed to gauge the potential impactof depression management in diabetes.
MEDLINE and PsycINFO databases and publishedreferences were used to identify studies that reported the prevalence of depression in diabetes. Prevalence was calculated as an aggregate mean weighted by the combined number of subjects in the includedstudies. We used
statistics and odds ratios (ORs) to assess the rate and likelihood of depression as afunction of type of diabetes, sex, subject source, depression assessment method, and study design.
 A total of 42 eligible studies were identified; 20 (48%) included a nondiabetic comparisongroup. In the controlled studies, the odds of depression in the diabetic group were twice that of thenondiabetic comparison group (OR = 2.0, 95% CI 1.8
2.2) and did not differ by sex, type of diabetes,subject source, or assessment method. The prevalence of comorbid depression was significantly higher indiabetic women (28%) than in diabetic men (18%), in uncontrolled (30%) than in controlled studies(21%), in clinical (32%) than in community (20%) samples, and when assessed by self-reportquestionnaires (31%) than by standardized diagnostic interviews (11%).
The presence of diabetes doubles the odds of comorbid depression. Prevalenceestimates are affected by several clinical and methodological variables that do not affect the stability of theORs.
Lasting Effects of a 2-Year Diabetes Self-Management Support Intervention:Outcomes at 1-Year Follow-Up
Tricia S. Tang, PhD; Martha M. Funnell, RN; Mary Oh, BS
Suggested citation for this article:
Tang TS, Funnell MM, Oh M. Lasting Effects of a 2-Year Diabetes Self-Management Support Intervention: Outcomes at 1-Year Follow-Up. Prev Chronic Dis 2012;9:110313.DOI: http://dx.doi.org/10.5888/pcd9.110313.
 Diabetes-related health improvements achieved from self-management education interventions arenot sustained long-term. We examined the health effects at 1 year follow-up of a 2-year,empowerment-based, diabetes self-management support intervention designed for African Americans.
 We collected data from 52 African American adults with type 2 diabetes who completed the 3-yearstudy. The intervention consisted of weekly groups led by 2 health care professionals and emphasizedexperiential learning, emotional coping, problem solving, goal setting, and action planning; groupdiscussion was guided by participant-identified self-management priorities and concerns.Measurements were taken at baseline, 24 months (postintervention), and 36 months (1 year follow-up) to assess glycemic control; weight; body mass index; serum cholesterol, high-density lipoproteincholesterol, and low-density lipoprotein cholesterol levels; systolic and diastolic blood pressure; self-care behaviors; diabetes-specific quality of life; and diabetes empowerment.
 Following the 2-year diabetes self-management support intervention, we found significantimprovements for following a healthy diet (
= .03), spacing carbohydrates evenly across the day (
=.005), using insulin as recommended (
= .047), and achieving diabetes-specific quality of life (
=.02). At 1-year follow-up, not only did participants sustain the behavioral improvements made in the2-year diabetes self-management support intervention, but they also demonstrated additionalimprovements in glycemic control (
< .001) and in serum cholesterol (
< .001) and low-densitylipoprotein cholesterol levels (
= .001).
 Participation in an empowerment-based diabetes self-management support intervention may have apositive and enduring effect on self-care behaviors and on metabolic and cardiovascular health.
The Effect of Nurse
led Diabetes Self 
management Education on GlycosylatedHemoglobin and Cardiovascular RiskFactors: A Meta
PurposeThe purpose of this meta-analysis was to determine the effect of nurse-led diabetes self-managementeducation (DSME) on blood glucose control and cardiovascular risk factors.MethodsThe electronic databases PubMed and ISIS Knowledge were searched for relevant randomized controlledstudies published between 1999 and 2009. Effect size was calculated for change in A1C, blood pressure,and lipid levels using both fixed- and random-effects models. Subgroup analyses were performed onpatient age, gender, diabetes type, baseline A1C, length of follow-up, and study setting.Results A total of 34 randomized controlled trials with a combined cohort size of 5993 patients was identified.Mean patient age was 52.8 years, 47% were male, and mean A1C at baseline was 8.5%. Mean change
in A1C was a reduction by −0.70% for nurse
led DSME versus −0.21% with usual care (UC). This
corresponded to an effect size of 0.506, using a random-effects model for nurse-led DSME versus UC.Effect size was significantly associated with patient age older than 65 years and with duration of follow-up. Nurse-led DSME was also associated with improvements in cardiovascular risk factors, particularlyamong male patients, among those with good glycemic control, and in studies conducted in the UnitedStates.ConclusionsNurse-led DSME is associated with improved glycemic control, demonstrating that programs are mosteffective among seniors and with follow-up periods of 1 to 6 months. Future programs tailored to theneeds of patients younger than 65 years may improve the impact of DSME on blood glucose.

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