Better Diabetes Self-Management With Cognitive Therapy

Mind-Body connections are increasingly acknowledged to render meaningful perspective and dynamic contributions to the management of complex chronic conditions. Stress that generates chronic, irregular cortisol levels is well understood to influence endocrine functions such as the secretion of insulin at the heart of diabetes.

This article affirms that cognition enhancing approaches (CBT) to address physiological dysfunctions are increasingly recognized, evidence based components of a successful strategy to create healthy change.

Peter M. Yellowlees, MBBS, MD

Director, Health Informatics, University of California, Davis, Sacramento, California

June 20, 2014

This is the Medscape Psychiatry Minute. I’m Dr. Peter Yellowlees.

We know that diabetic control of patients who are depressed and have diabetes is improved if their depression is treated. Now a team of investigators[1] from Massachusetts General Hospital in Boston have performed a randomized controlled trial to test cognitive-behavioral therapy (CBT) for adherence and depression in 87 adults with unipolar depression and uncontrolled type 2 diabetes.

The control patients received treatment as usual, including medication adherence, self-monitoring of blood glucose, and lifestyle counseling, whereas those assigned to the intervention arm also received 9-11 sessions of CBT focused on adherence and depression. Analyses of 4-, 8-, and 12-month follow-up time points indicated that the intervention group maintained 24% higher medication adherence, 17% greater adherence to self-monitoring of blood glucose, and lower A1c values, with both groups being less depressed.

The researchers concluded that CBT has enduring and clinically meaningful benefits for diabetes self-management and glycemic control in adults with type 2 diabetes and depression. This is yet more evidence in support of the effectiveness of CBT in many areas of medicine and reminds us of their importance in clinical practice.

This article is selected from Medscape Best Evidence. I’m Dr. Peter Yellowlees.

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