Evaluation of a Diabetes-specific Cognitive Behavioural Treatment for Subthreshold Depression

Study Results

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Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

214 participants

Study Classification

INTERVENTIONAL

Study Start Date

2009-11-30

Study Completion Date

2012-05-31

Brief Summary

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This work is supported by the "Kompetenznetz Diabetes mellitus (Competence Network for Diabetes mellitus)" funded by the Federal Ministry of Education and Research (FKZ 01GI0809).

Approximately one third of diabetic patients has elevated depressive symptoms. The majority of these patients are suffering from a subthreshold depression. In spite of the fact that subthreshold depression has an equivalent negative impact on the prognosis of diabetes as clinical depression, there is no specific intervention tool. The main objective of this project is to develop a diabetes specific cognitive behavioural treatment (DS-CBT) for diabetic patients with subthreshold depression. In a randomized trail DS-CBT is compared to standard diabetes education. A total of 188 diabetic patients will be recruited and randomly assigned to the two treatment conditions. The expected main outcome is the reduction of subthreshold depression under DS-CBT in a 12 month follow up. Secondary variables are improvement of glycaemic control, quality of life, diabetes self-management as well as reduction of health care costs and modification of inflammatory parameters.

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Detailed Description

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Elevated rates for depression in diabetic patients are of clinical significance for diabetology. Depressive disorders are doubled compared to patients without diabetes. A meta-analysis showed that a proportion of 20% of diabetic patients showed subthreshold depression, defined as elevated depressive symptoms without meeting criteria for clinical depression. Depression in diabetes is associated with a reduced quality of life, more diabetes related distress, and higher health related costs. But besides this, depression in diabetes seems to be an independent negative prognostic factor for morbidity and mortality. Furthermore subthreshold depression is a major barrier of an effective self-management of the disease.

Until now antidepressive therapies are only evaluated in clinically depressed diabetic patients. For the majority of depressed diabetic patients suffering from subthreshold depression no evaluated specific intervention concept exists. Since subthreshold depression often is associated with diabetes related distress a diabetes specific intervention was developed to support patients to increase their problem solving skills, modify their depressive cognitions and improve their coping with diabetes related distress. It consists of five sessions and is delivered as a group intervention.

This study is an efficacy trial. In this randomized trial the efficacy of this newly developed intervention is compared to a control condition consisting of five standard diabetes education lessons. The primary outcome variable is the reduction of depressive symptoms twelve months after the intervention. Secondary outcome variables are the quality of life, metabolic parameters, self-care behavior and other psychosocial aspects. Furthermore the possible covariation between change of depressive symptoms and inflammatory and immune markers will be analyzed.

Conditions

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Depressive Symptoms Diabetes Mellitus

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Diabetes-Specific CBT (DS-CBT)

Cognitive Behavioral Intervention (Group) focusing on Diabetes-Specific Problems

Group Type EXPERIMENTAL

Diabetes-Specific CBT (DS-CBT)

Intervention Type BEHAVIORAL

5 Group Sessions with a duration of 90 Minutes each, including the following cognitive-behavioral Intervention Methods focusing on Diabetes Distress and Hassles:

* Problem Analysis and Definition
* Problem Solving Intervention
* Cognitive Restructuring
* Activation of personal and social Resources
* Goal Definition and Agreement

Standard Diabetes Education

Standard Diabetes Education Lessons will be given to quantify the unspecific antidepressive Effects of Participation in Group Sessions with social Contact and Acquisition of Knowledge.

Group Type ACTIVE_COMPARATOR

Standard Diabetes Education

Intervention Type BEHAVIORAL

Standard Diabetes Education Lesson including

* Health Care and specific Topics (e. g. Blood Pressure)
* Social Aspects of Living with Diabetes
* Diabetes Complications
* Sports, Activities and Exercise
* Healthy and unhealthy Food, Vitamins, Cooking Recommendations and Recipes
* Foot Care: Exercises, Care and Control, Sensibility, Injuries, diabetic Neuropathy

Interventions

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Diabetes-Specific CBT (DS-CBT)

5 Group Sessions with a duration of 90 Minutes each, including the following cognitive-behavioral Intervention Methods focusing on Diabetes Distress and Hassles:

* Problem Analysis and Definition
* Problem Solving Intervention
* Cognitive Restructuring
* Activation of personal and social Resources
* Goal Definition and Agreement

Intervention Type BEHAVIORAL

Standard Diabetes Education

Standard Diabetes Education Lesson including

* Health Care and specific Topics (e. g. Blood Pressure)
* Social Aspects of Living with Diabetes
* Diabetes Complications
* Sports, Activities and Exercise
* Healthy and unhealthy Food, Vitamins, Cooking Recommendations and Recipes
* Foot Care: Exercises, Care and Control, Sensibility, Injuries, diabetic Neuropathy

Intervention Type BEHAVIORAL

Other Intervention Names

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Diabetes-Specific Cognitive-Behavioral Group Sessions Educative Group Lesson and Discussion

Eligibility Criteria

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Inclusion Criteria

* Diabetes mellitus
* Elevated depressive symptoms (regarding to CES-D)
* Age \>= 18 and \<=70
* Sufficient German language skills
* Informed consent

Exclusion Criteria

* Current MDD
* Current schizophrenia/ psychotic disorder, eating disorder, bipolar disorder, addictive disorder, personality disorder
* Current antidepressive medication
* Current psychotherapy
* Severe physical illness (i.e. cancer)
* Being bedridden
* Guardianship

Minimum Eligible Age

18 Years

Maximum Eligible Age

70 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No