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 (P
trend=.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.
Key words glycemic control - depression - diabetes - hispanics - primary care
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.
Presented in part as a poster at the annual meeting of the American Psychiatric Association, New Orleans, La, May 8, 2001.
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).