Effectiveness of Behavioral Activation Treatment for Depression and HbA1C in Diabetics type II

Abstract

Behavioral activation is the principal non-pharmacologic method for the management of depression, but its usefulness for depressed patients with diabetes remains unknown. The aim of this study was to assess the efficacy of behavioral activation therapy (BA) for depression in patients with diabetes. Patients with type 2 diabetes and major depression (n = 29) were randomized to 16 sessions of behavioral activation (n = 15) and control group (n = 14). All patients participated in a diabetes education program to control for the effects of supportive attention and the possible influence of enhanced diabetes control on mood. The main outcome was depression, measured with the Beck Depression Inventory (BDI-II) assessed at 0, 2, 4, 6, 8, 10, 12, 14, 16 and 4 months, and the glycemic control was measured by using hemoglobin A1C levels, Outcomes were assessed immediately after treatment and 4 months after treatment.  The percentage of patients achieving remission of depression (Beck Depression Inventory score < 9) was greater in the BA group than in the control group: post-treatment 75% of patients in the BA group (9 of 12) compared with 14.2% of controls (2 of 14) achieved remission (difference, 60.8 percentage points (P < 0.01); at follow-up 66.6% of patients in the BA group (8 of 12) compared with 15.3% of controls(2 of 13) achieved remission (P = 0.03). Post-treatment HbA1C levels were not different in the two groups, but follow-up mean HbA1C levels were significantly better in the BA group than in the control group (9.5% compared with 10.9%; P = 0.03). The combination of Behavioral activation and supportive diabetes education is an effective non-pharmacologic treatment for major depression in patients with type 2 diabetes. It can successfully be disseminated into routine practice settings in Iran and it may also be associated with improved glycemic control.