Saturday, November 3, 2007

This presentation is part of : Acute and Chronic Adult Healthcare Issues
Prediction of HbA1c Control in Type 2 Diabetes
Hyeon Joo Lee, MS, RN1, Chi-Wen Kao, PhD, RN2, Deborah W. Chapa, PhD, ACNP-BC3, Deborah Jones, PhD, RN1, Jane Kapustin, PhD, CRNP1, Joan Davenport, PhD, RN1, Sue A. Thomas, PhD, RN, FAAN1, Erika Friedmann, PhD1, Catherine M. Krichten, RN, MS, CRNP, CDE4, and Thomas W. Donner, MD5. (1) School of Nursing, University of Maryland, Baltimore, MD, USA, (2) School of Nursing, National Defense Medical Center, Taiwan, Taipei, Taiwan, (3) School of Nursing, Florida Gulf Coast University, Fort Myers, FL, USA, (4) Joslin Diabetes Center, Division of Endocrinology, Nutrition & Diabetes, University of Maryland, Baltimore, MD, USA, (5) School of Medicine, University of Maryland, Baltimore, MD, USA
Learning Objective #1: explain the relationship between depression and outcomes in diabetics.
Learning Objective #2: to explain that the interrelationship of depression, diabetes control, and co morbidities has been established in type 1 but not type 2 diabetics.

Problem: Depression leads to poorer outcomes and increased risk of complications in diabetics.  Investigations based on the theory of a reciprocal relationship between depression and diabetes resulting from the disregulation of hypothalamic-pituitary axis have not established underlying mechanisms or direct causal relationship.  Depression is correlated with poor glycemic control (HbA1c) in type 1diabetes.  A similar relationship has not been established in type 2 diabetes.

Objective: This study was conducted to examine whether diabetes-related complications, depression, or quality of life predict diabetes control beyond the contributions of demographic characteristics in type 2 diabetes?

Design: Cross sectional survey

Population, Sample, Setting: Type 2 diabetics (N=55) aged  ³35 years, 42% female, 36% African American were recruited by convenience sample from an inner city Joslin diabetes clinic.

Variables: Dependent: HbA1c; Independent: demographics, depression, quality of life (QOL), diabetes-related macro (coronary artery disease, hyperlipidemia, hypertension, obesity) and micro (nephropathy, neuropathy, retinopathy) co-morbidities

Methods: After informed consent patients completed Beck Depression Inventory-II (BDI, depression),  SF-36 (QOL), demographic questionnaire.  Complications, HbA1c, height and weight were obtained from the medical record. 

Findings: HbA1c: 40% well controlled (≤7%), 44% moderate-high (7-9%), and 16% very high (³ 9%).  All patients had at least 1 diabetes-related co-morbidity; 58% had ³ 1 micro co-morbidities; 64% had 2 -3 macro co-morbidities;  41% were depressed (BDI ³13); 27% moderately or severely depressed (BDI ³20).  Being black tended to predict higher HbA1c [F(1,51)=3.321, p=.074, R2=.06].  Neither gender nor age added significantly to prediction of HbA1c.  Neuropathy [F(1,50)=.979, p=.007, R2=.158] and retinopathy [F(1,50) =3.610, p=.063, R2=.089] added to the prediction beyond race, other co-morbidities didn’t.  Depression tended to add to prediction of HbA1c [F(1,50)=3.728, p=.059, R2=.091]; QOL did not.

Conclusion:  Longitudinal research is necessary to clarify the inter-relationship of depression, quality of life, self-care behaviors, and diabetes control in type 2 diabetics.