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Cognitive Behavior Therapy for Depression in Type 2 Diabetes Mellitus: A Randomized, Controlled Trial
Abstract
BACKGROUND: Psychotherapy is the principal nonpharmacologic method for the management of depression, but its usefulness for depressed patients with diabetes remains unknown. OBJECTIVE: To assess the efficacy of cognitive behavior therapy (CBT) for depression in patients with diabetes. DESIGN: Randomized, controlled trial. SETTING: Referral-based academic medical center. PATIENTS: 51 patients with type 2 diabetes and major depression. INTERVENTION: Patients were assigned either to a group that received 10 weeks of individual CBT or to a control group that received no specific antidepressant treatment. All patients participated in a diabetes education program to control for the effects of supportive attention and the possible influence of enhanced diabetes control on mood. MEASUREMENTS: Degree of depression was measured by using the Beck Depression Inventory; glycemic control was measured by using glycosylated hemoglobin levels. Outcomes were assessed immediately after treatment and 6 months after treatment. RESULTS: The percentage of patients achieving remission of depression (Beck Depression Inventory score < or = 9) was greater in the CBT group than in the control group: posttreatment, 85.0% of patients in the CBT group (17 of 20) compared with 27.3% of controls (6 of 22) achieved remission (difference, 57.7 percentage points [95% CI, 33 to 82 percentage points]) (P < 0.001); at follow-up, 70.0% of patients in the CBT group (14 of 20) compared with 33.3% of controls (7 of 21) achieved remission (difference, 36.7 percentage points [CI, 9 to 65 percentage points]) (P = 0.03). Post-treatment glycosylated hemoglobin levels were not different in the two groups, but follow-up mean glycosylated hemoglobin levels were significantly better in the CBT group than in the control group (9.5% compared with 10.9%; P = 0.03). CONCLUSIONS: The combination of CBT and supportive diabetes education is an effective nonpharmacologic treatment for major depression in patients with type 2 diabetes. It may also be associated with improved glycemic control.
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“Cognitive-behavioural therapy has been shown to be a valuable treatment for patients with other long-term physical health conditions, improving wellbeing and enabling them to manage their symptoms more effectively.”
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“CBT has been shown to improve psychological well-being within a number of different physical health conditions, including Chronic Fatigue Syndrome 6-7 , Chronic Pain 8 , Diabetes 9 and Chronic Obstructive Pulmonary Disease 10 .”
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“The use of CBT in diabetes focuses on changes to concrete behaviours in everyday life in order to strengthen self-care, improve glucose control and well-being, and to treat comorbid depression.(12) In the diabetes field, a Dutch research group has evaluated CBT-based online support for adults with type 1 and type 2 di…”
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Metadata
- Authors
- Lustman, P. J., Griffith, L. S., Freedland, K. E., Kissel, S. S., & Clouse, R. E.
- Affiliations
- Washington University in St. Louis (US)
- Corresponding author
- Lustman, Patrick J.
- ORCID
- Lustman, Patrick J.
- Venue
- Annals of Internal Medicine
- Publisher
- American College of Physicians
- Published
- 1998-10-15
- Volume
- 129
- Issue
- 8
- Pages
- 613-621
- ISSN
- 0003-4819 (ISSN-L)
- 1539-3704
- OpenAlex
- W1966243965
- Cited by
- 562
- References
- 47
- Citations by year
- 2026: 5 · 2025: 3 · 2024: 8 · 2023: 10 · 2022: 9 · 2021: 7 · 2020: 11 · 2019: 16 · 2018: 16 · 2017: 17 · 2016: 24 · 2015: 20 · 2014: 20 · 2013: 21 · 2012: 28
- FWCI
- 18.00
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Annals of Internal Medicine (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute of Mental Health (R21MH52629, R21MH052629)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Social Sciences › Psychology › Clinical Psychology › Psychological Treatments and Assessments
- Keywords
- cognitive behavioral therapy, depression, type 2 diabetes, major depressive disorder, glycemic control, HbA1c, diabetes education, non-pharmacological treatment, depression remission
- MeSH terms
- Adult, Aged, Analysis of Variance, Blood Glucose, Depression, Diabetes Mellitus, Type 2, Female, Humans, Male, Middle Aged, Patient Compliance, Patient Education as Topic, Blood Glucose Self-Monitoring, Cognitive Behavioral Therapy
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