认知行为疗法治疗1型糖尿病患者的抑郁症及提高依从性：初步数据与可行性
Cognitive-behavioral therapy for the treatment of depression and adherence in patients with type 1 diabetes: pilot data and feasibility.
作者信息
Markowitz Sarah M, Carper Matthew M, Gonzalez Jeffrey S, Delahanty Linda M, Safren Steven A
机构信息
Department of Psychology, Wells College, Aurora, New York (Dr Markowitz); Ferkauf Graduate School of Psychology and Albert Einstein College of Medicine, Yeshiva University, New York, NewYork (Dr Gonzalez); and Diabetes Research Center (Ms Delahanty) and Behavioral Medicine Service (Mr Carper and Dr Safren), Massachusetts General Hospital and Harvard Medical School, Boston.
出版信息
Prim Care Companion CNS Disord. 2012;14(2). doi: 10.4088/PCC.11m01220. Epub 2012 Mar 15.
OBJECTIVE
Depression is one of the most common psychological problems affecting individuals with type 1 diabetes, and it is associated with treatment nonadherence and worse clinical outcomes. The research on treating depression or nonadherence in adults with type 1 diabetes is limited. We adapted an evidence-supported treatment, individual cognitive-behavioral therapy for adherence and depression (CBT-AD), for type 1 diabetes and examined its feasibility, acceptability, and potential for an effect.
METHOD
The pilot study included 9 patients with a DSM-IV diagnosis of major depression, dysthymia, or residual depressive symptoms despite treatment with an antidepressant; a diagnosis of type 1 diabetes per patient self-report; and a glycosylated hemoglobin A1c (HbA1c) level of 8.0% or greater. Patients were referred by their diabetes care providers to a behavioral medicine specialty setting and received 10 to 12 sessions of CBT-AD. Main outcome measures included percent of eligible participants who enrolled in the study, session attendance, independently-rated Montgomery-Asberg Depression Rating Scale (MADRS) score, self-reported adherence to diabetes care activities, and adherence to self-monitoring of blood glucose levels. Data were collected from June 27, 2008, through March 31, 2010.
RESULTS
There was a clinically meaningful decrease in depression severity (mean [SD] MADRS score decrease from 26.0 [4.73] to 12.3 [7.37], Cohen d = 2.90), demonstrated improvements in diabetes self-care (increase in blood glucose monitoring from 65.0 [26.72] to 82.7 [22.75], Cohen d = -0.66, and a difference in self-reported percent insulin doses in the past 2 weeks from 77.1 [29.84] to 87.1 [23.6], Cohen d = -0.34), and possible improvement in glycemic control (decrease in HbA1c levels from 9.6 [1.32] to 9.0 [1.04], Cohen d = 0.45).
CONCLUSIONS
These preliminary results provide evidence for the acceptability, feasibility, and potential utility of CBT-AD for patients with type 1 diabetes and depression.
TRIAL REGISTRATION
clinicaltrials.gov Identifier: NCT01527981.
目的
抑郁症是影响1型糖尿病患者的最常见心理问题之一，且与治疗依从性差及更差的临床结局相关。针对成年1型糖尿病患者抑郁症或治疗不依从的研究有限。我们对一种循证支持的治疗方法——针对依从性和抑郁症的个体认知行为疗法（CBT-AD）进行调整，用于1型糖尿病，并考察其可行性、可接受性及潜在疗效。
方法
该初步研究纳入9例患者，这些患者符合《精神疾病诊断与统计手册》第四版（DSM-IV）中重度抑郁症、心境恶劣或尽管接受抗抑郁药治疗仍有残留抑郁症状的诊断标准；每位患者自我报告确诊为1型糖尿病；糖化血红蛋白A1c（HbA1c）水平为8.0%或更高。患者由其糖尿病护理提供者转介至行为医学专科机构，接受10至12次CBT-AD治疗。主要结局指标包括参与研究的符合条件参与者的百分比、治疗课程出席率、独立评定的蒙哥马利-艾斯伯格抑郁量表（MADRS）评分、自我报告的糖尿病护理活动依从性以及血糖自我监测的依从性。数据收集时间为2008年6月27日至2010年3月31日。
结果
抑郁严重程度有临床意义的降低（平均[标准差]MADRS评分从26.0[4.73]降至12.3[7.37]，科恩d值=2.90），糖尿病自我护理有改善（血糖监测从65.0[26.72]次增加至82.7[22.75]次，科恩d值=-0.66，过去2周自我报告的胰岛素剂量百分比从77.1[29.84]变为87.1[23.6]，科恩d值=-0.34），血糖控制可能有所改善（HbA1c水平从9.6[1.32]降至9.0[1.04]，科恩d值=0.45）。
结论
这些初步结果为CBT-AD对1型糖尿病合并抑郁症患者的可接受性、可行性及潜在效用提供了证据。
试验注册
美国国立医学图书馆临床试验注册中心标识符：NCT01527981。
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