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Diabetes Educ. 2004 May-Jun;30(3):485-92.

Depression increases diabetes symptoms by complicating patients' self-care adherence.

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Veterans Affairs and Stanford University Medical Centers, Palo Alto, California
Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
Veterans Affairs Center for Practice Management and Outcomes Research, Department of Internal Medicine, University of Michigan, and Michigan Diabetes Research and Training Center, Ann Arbor, Michigan



This study evaluated whether diabetes patients with depressive symptoms are more likely than other diabetes patients to report symptoms of glucose dysregulation, and whether this relationship is mediated by the impact of depressive symptoms on patients' adherence to their diabetes self-care regimen.


Participants were English- and Spanish-speaking adults with type 2 diabetes. Interviewers assessed participants' depressive symptoms and diabetes-related symptoms at baseline. Self-care behaviors and diabetes symptoms were measured at a 1-year follow-up. Structural equation models were used to determine whether depression affected diabetes symptoms by limiting patients' ability to adhere to self-care recommendations.


An initial model identified direct effects of baseline depressive symptoms on self-care and diabetes symptoms at follow-up. The relationship between self-care behaviors and physical symptoms of poor glycemic control were assessed using a second model. Results explained the relationship between depressive symptoms at baseline and diabetes symptoms at 1 year.


Depressive symptoms impact subsequent physical symptoms of poor glucose control by influencing patients' ability to adhere to their self-care regimen. More aggressive management of depression among patients with diabetes may improve their physical health as well as their mental health.

[Indexed for MEDLINE]

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