Depression and glycemic control in Hispanic primary care patients with diabetes.

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 A(1c) (HbA(1c)) tests.

MAIN OUTCOME MEASURE

Probability of PGC (HbA(1c)>or=8%).

RESULTS

Probability for PGC steadily increased with severity of depression. Thirty-nine (55.7%) of the 70 patients with major depression had HbA(1c)>or=8%, 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.