A diabetes support intervention involving text messaging was found to be helpful for blood glucose control in people with symptoms of depression, and even helped reduce those symptoms over time, according to a new study published in the Journal of Diabetes and its Complications.
It has long been established that people with diabetes are at greater risk for depression, but the link between these two conditions doesn’t end there. Having depression has been shown to reduce the effectiveness of certain diabetes management and prevention programs, and it is linked to a higher risk of death in people with type 2 diabetes. There is even evidence to suggest that a person’s risk for depression goes up along with blood glucose levels even before these levels reach the threshold for diabetes.
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Against this backdrop, researchers were interested in whether a diabetes support intervention using text messaging was as effective in people who report symptoms of depression as in those without depressive symptoms. They performed a secondary analysis of data from a study that wasn’t designed at all to address depression — it was designed to look at the effectiveness of the support program on blood glucose control, but also collected data on depressive symptoms along with symptoms of many other conditions. The study had 506 adult participants with type 2 diabetes, who completed a health questionnaire and had their A1C level (a measure of long-term blood glucose control) measured at the beginning of the study and after six months.
The diabetes support intervention involved both one-way and two-way text messaging, as noted in a Healio article on the study. One-way messages from study staff to participants included tips to stick with taking medications as prescribed, provided information on medications, and supported healthy self-care behaviors. Interactive messaging was used to support taking prescribed medications and to give encouragement and feedback on progress in diabetes management.
Depression not always a barrier to improving self-care
For the latest study on depression, researchers looked at the effects of the intervention after six months — rather than the full 12 months — because that’s when the average A1C reduction among participants was greatest. At the beginning of the study, 22% of participants indicated having depressive symptoms. Among all participants, 44% had an A1C level of 8.5% or higher, and this group was even more likely to have depressive symptoms. For these participants with high A1C, the text messaging intervention was just as effective at improving blood glucose control in participants with depressive symptoms as in those without them — demonstrating that depression isn’t always a barrier to improving diabetes self-care. What’s more, 278 participants with an A1C level below 8.5% at the beginning of the study showed an improvement in their depressive symptoms after six months. Depressive symptoms did not improve overall in participants who started out with an A1C level of 8.5% or higher.
The researchers concluded that depressive symptoms may not always reduce the effectiveness of interventions aimed at improving diabetes self-care and blood glucose control — and, in fact, that the interventions could even have a beneficial effect on depressive symptoms. More research is needed to find out if other types of interventions, like diabetes education sessions, might also help reduce depressive symptoms in people with diabetes.
Want to learn more about maintaining mental health? Read “Dealing With Diabetes and Depression.”