Relationship of depression and diabetes self-care, medication adherence, and preventive care

Diabetes Care. 2004 Sep;27(9):2154-60. doi: 10.2337/diacare.27.9.2154.


Objective: We assessed whether diabetes self-care, medication adherence, and use of preventive services were associated with depressive illness.

Research design and methods: In a large health maintenance organization, 4,463 patients with diabetes completed a questionnaire assessing self-care, diabetes monitoring, and depression. Automated diagnostic, laboratory, and pharmacy data were used to assess glycemic control, medication adherence, and preventive services.

Results: This predominantly type 2 diabetic population had a mean HbA(1c) level of 7.8 +/- 1.6%. Three-quarters of the patients received hypoglycemic agents (oral or insulin) and reported at least weekly self-monitoring of glucose and foot checks. The mean number of HbA(1c) tests was 2.2 +/- 1.3 per year and was only slightly higher among patients with poorly controlled diabetes. Almost one-half (48.9%) had a BMI >30 kg/m(2), and 47.8% of patients exercised once a week or less. Pharmacy refill data showed a 19.5% nonadherence rate to oral hypoglycemic medicines (mean 67.4 +/- 74.1 days) in the prior year. Major depression was associated with less physical activity, unhealthy diet, and lower adherence to oral hypoglycemic, antihypertensive, and lipid-lowering medications. In contrast, preventive care of diabetes, including home-glucose tests, foot checks, screening for microalbuminuria, and retinopathy was similar among depressed and nondepressed patients.

Conclusions: In a primary care population, diabetes self-care was suboptimal across a continuum from home-based activities, such as healthy eating, exercise, and medication adherence, to use of preventive care. Major depression was mainly associated with patient-initiated behaviors that are difficult to maintain (e.g., exercise, diet, medication adherence) but not with preventive services for diabetes.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Body Mass Index
  • Depressive Disorder / epidemiology*
  • Diabetes Complications / psychology
  • Diabetes Mellitus / drug therapy
  • Diabetes Mellitus / prevention & control
  • Diabetes Mellitus / psychology*
  • Health Maintenance Organizations
  • Health Surveys
  • Humans
  • Hypoglycemic Agents / administration & dosage
  • Hypoglycemic Agents / therapeutic use
  • Obesity / complications
  • Obesity / psychology
  • Self Care*
  • Surveys and Questionnaires
  • Washington


  • Hypoglycemic Agents