A randomized trial of telephonic counseling plus walking for depressed diabetes patients
Open accessAbstract
BACKGROUND: Patients with diabetes and depression often have self-management needs that require between-visit support. This study evaluated the impact of telephone-delivered cognitive behavioral therapy (CBT) targeting patients' management of depressive symptoms, physical activity levels, and diabetes-related outcomes. METHODS: Two hundred ninety-one patients with type 2 diabetes and significant depressive symptoms (Beck Depression Inventory scores ≥ 14) were recruited from a community-based, university-based, and Veterans Affairs health care systems. A manualized telephone CBT program was delivered weekly by nurses for 12 weeks, followed by 9 monthly booster sessions. Sessions initially focused exclusively on patients' depression management and then added a pedometer-based walking program. The primary outcome was hemoglobin A1c levels measured at 12 months. Blood pressure was a secondary outcome; levels of physical activity were determined by pedometer readings; depression, coping, and health-related quality of life were measured using standardized scales. RESULTS: Baseline A1c levels were relatively good and there was no difference in A1c at follow-up. Intervention patients experienced a 4.26 mm Hg decrease in systolic blood pressure relative to controls (P=0.05). Intervention patients had significantly greater increases in step counts (mean difference, 1131 steps/d; P=0.0002) and greater reductions in depressive symptoms (58% remitted at 12 mo vs. 39%; P=0.002). Intervention patients also experienced relative improvements in coping and health-related quality of life. CONCLUSIONS: This program of telephone-delivered CBT combined with a pedometer-based walking program did not improve A1c values, but significantly decreased patients' blood pressure, increased physical activity, and decreased depressive symptoms. The intervention also improved patients' functioning and quality of life.
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Adding physical activity to routine self-management has been shown to improve the health and mental well-being of people with diabetes.
“Incorporation of a physical activity regimen into routine self-management has also been shown to improve the health and mental well-being of PWD (58,59).”
From Psychosocial care for people with diabetes: a position statement of the American Diabetes Association (2016) · cites this paper as [58]
Older adults with diabetes and comorbid depression are likely to benefit from a collaborative care approach using a nurse care manager supervised by a primary care physician and psychiatrist.
“Within the primary care setting, older adults with diabetes and comorbid depression are likely to benefit from a collaborative care intervention approach, which uses a nurse care manager supervised by a primary care physician and psychiatrist (58,112,113).”
From Psychosocial care for people with diabetes: a position statement of the American Diabetes Association (2016) · cites this paper as [58]
CBT-based intervention could effectively improve glycemic control, including HbA1c and fasting blood glucose, as well as diastolic blood pressure in patients with diabetes.
“Consistent with previous studies 24,45,56,64 , our meta-analysis showed that CBT-based intervention could effectively improve glycemic control, including HbA 1c and fasting blood glucose, as well as diastolic blood pressure in patients with diabetes.”
From The efficacy of cognitive behavioral therapy-based intervention on patients with diabetes: a meta-analysis (2022) · cites this paper as [45]
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- Authors
- Piette, J. D., Richardson, C., Himle, J., Duffy, S., Torres, T., Vogel, M., Barber, K., & Valenstein, M.
- Affiliations
- University of Michigan (US)
- Corresponding author
- Piette, John D.
- Richardson, Caroline
- Duffy, Sonia
- Valenstein, Marcia
- Venue
- Medical Care
- Published
- 2011-07
- Volume
- 49
- Issue
- 7
- Pages
- 641-648
- ISSN
- 0025-7079 (ISSN-L)
- PMC
- PMC3117978
- OpenAlex
- W1984876495
- Cited by
- 198
- References
- 53
- Citations by year
- 2026: 4 · 2025: 10 · 2024: 12 · 2023: 20 · 2022: 15 · 2021: 17 · 2020: 7 · 2019: 12 · 2018: 10 · 2017: 7 · 2016: 12 · 2015: 21 · 2014: 19 · 2013: 15 · 2012: 13
- FWCI
- 13.10
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Medical Care (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Heart, Lung, and Blood Institute (K23HL075098)
- National Institute of Diabetes and Digestive and Kidney Diseases (DK020572, P60DK020572, R18DK066166, 5R18DK66166-3, P30DK020572)
- National Center for Research Resources (UL1RR024986)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
- Keywords
- type 2 diabetes, depression, physical activity, glycemic control, HbA1c, blood pressure, coping, health-related quality of life, nurse-led intervention, booster sessions
- MeSH terms
- Adaptation, Psychological, Aged, Blood Pressure, Depression, Diabetes Mellitus, Type 2, Female, Glycated Hemoglobin, Humans, Male, Middle Aged, Psychometrics, Quality of Life, Socioeconomic Factors, Telephone, Cognitive Behavioral Therapy, Body Mass Index, Walking, Treatment Outcome
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