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Depression and glycemic control in hispanic primary care patients with diabetes

  • Mini-Symposium On Diabetes Original Articles
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Abstract

CONTEXT: Maintaining optimal glycemic control is an important goal of therapy in patients with diabetes mellitus. Patients of Hispanic ancestry have been shown to have high rates of diabetes and poor glycemic control (PGC). Although depression is common in adults with diabetes, its relationship to glycemic control remains unclear, especially among Hispanics.

OBJECTIVE: To assess the association of depression with PGC in Hispanics.

DESIGN: Data from a cross-sectional mental health survey in primary care were crosslinked to the hospital’s computerized laboratory database.

SETTING: Urban general medicine practice at a teaching hospital.

PATIENTS: Two hundred and nine patients (mean [standard deviation] age, 57.1 [10.3] years; 68% females) with recent International Classification of Diseases, Ninth Revision (ICD-9) codes for diabetes mellitus, and 1 or more hemoglobin A1c (HbA1c) tests.

MAIN OUTCOME MEASURE: Probability of PGC (HbA1c ≥8%).

RESULTS: Probability for PGC steadily increased with severity of depression. Thirty-nine (55.7%) of the 70 patients with major depression had HbA1c ≥80%, compared with 39/92 (42.4%) in the minimal to mild depression group, and 15/47 (31.9%) in the no depression group (Ptrend=.01; adjusted odds ratio, 3.27; 95% confidence interval, 1.23 to 8.64, for moderate or severe depression vs no depression). Only 29 (41.4%) of the patients with major depression received mental health treatment in the previous year.

CONCLUSIONS: In this primary care sample of Hispanic patients with diabetes, we found a significant association between increasing depression severity and PGC. Yet, less than one half of the patients with moderate or severe depression received mental health treatment in the previous year. Improving identification and treatment of depression in this high-risk population might have favorable effects on diabetic outcomes.

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Authors and Affiliations

  1. Division of Clinical and Genetic Epidemiology, New York State Psychiatric Institute, New York, NY, USA

    Raz Gross MD, MPH, Mark Olfson MD, MPH, Marc J. Gameroff PhD, Adriana Feder MD, Milton Fuentes PsyD & Myrna M. Weissman PhD

  2. Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY, USA

    Raz Gross MD, MPH, Mark Olfson MD, MPH, Adriana Feder MD & Myrna M. Weissman PhD

  3. Division of General Medicine, Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY, USA

    Olveen Carasquillo MD, MPH, Steven Shea MD, Adriana Feder MD & Rafael Lantigua MD

  4. Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 West 168th Street, 10032, New York, NY

    Raz Gross MD, MPH, Steven Shea MD & Myrna M. Weissman PhD

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  1. Raz Gross MD, MPH
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  2. Mark Olfson MD, MPH
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Correspondence to Raz Gross MD, MPH.

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The authors do not have any financial or personal relationship between themselves and others that might have biased this work. The study sponsors had no role in the study design, data collection, analysis, and interpretation, or the preparation of the manuscript. The authors had full access to the data, and accept responsibility for the integrity of the data and the accuracy of data analysis.

See editorial by Vinicor, p. 483.

This study was supported by investigator-initiated grants from Upjohn, Kalamazoo, MI (Dr. Weissman); by training grant 5T32-MH13043 from the National Institute of Mental Health, Rockville, MD (Dr. Gross); and by grant P30-AG15294 from the National Institute of Aging, Bethesda, MD (Drs. Shea and Lantigua).

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Gross, R., Olfson, M., Gameroff, M.J. et al. Depression and glycemic control in hispanic primary care patients with diabetes. J GEN INTERN MED 20, 460–466 (2005). https://doi.org/10.1111/j.1525-1497.2005.30003.x

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