Lustman et al 2000

Using physiological measure to

assess adherence to medication and
the treatment of depression in
diabetics.
People with poorly controlled diabetes are more likely to
have depression. This may be because depression leads to
problems with adherence to medication and diet, and affects
quality of life.

Aim:
 To see if there was a link between depression and non adherence in diabetic patients
medication.
 To assess the effectiveness of fluoxetine as treatment for depression in patients with
diabetes

Volunteers were asked for but excluded If they had a history of substance abuse or mental disorder
etc. The 60 diabetic patients (Type 1 and 2) were all screened for depression (Using the Becks
Depression Inventory) and then randomly assigned to two groups, one group given fluoxetine for
depression and the other group given an identical looking pill as a placebo. The patients
themselves and the doctors did not know which group they had been assigned to in order to avoid
demand characteristics. (Double blind)

After 8 weeks Patients were re-assessed for depression and also assessed on their adherence to
their medial regime. (eg changing their diet and administering insulin by injection). This was done
by measuring their blood sugar levels.

They found that the group given the real fluoxetine had far healthier blood glucose levels compared
to the placebo group. Patients who reported less depressive symptoms also more regularly
monitored their blood glucose levels.

Measuring blood sugar in patients with diabetes indicates their levels of adherence to prescribed
medical regimes. Greater adherence was shown by patients who were less anxious suggesting that
reduced depression improves compliance with medical requests. (At the time critics thought that
the drug itself may have had an effect on the diabetes. However Lustman disproved this in later
trials in 2005).
Evaluate this study in terms of Generalisability, Reliability, Validity and ethics.

Generalisability

Reliability

Validity

Ethics
What is meant by ‘double What was the
blind’? experimental design?

What were the aims of Outline the procedure

the experiment?

Who were the sample? Outline the findings

How reliable was the How valid was the study?

study?

What ethical issues are Give one conclusion

there?