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A randomized trial of telephonic counseling plus walking for depressed diabetes patients
Piette JD, Richardson C, Himle J, Duffy S, Torres T, Vogel M, Barber K, Valenstein M
Medical Care 2011 Jul;49(7):641-648
clinical trial
7/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: Yes; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: No; Adequate follow-up: Yes; Intention-to-treat analysis: Yes; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

BACKGROUND: Patients with diabetes and depression often have self-management needs that require between-visit support. This study evaluated the impact of telephone-delivered cognitive behavioral therapy (CBT) targeting patients' management of depressive symptoms, physical activity levels, and diabetes-related outcomes. METHODS: Two hundred ninety-one patients with type 2 diabetes and significant depressive symptoms (Beck Depression Inventory scores >= 14) were recruited from a community-based, university-based, and Veterans Affairs health care systems. A manualized telephone CBT program was delivered weekly by nurses for 12 weeks, followed by 9 monthly booster sessions. Sessions initially focused exclusively on patients' depression management and then added a pedometer-based walking program. The primary outcome was hemoglobin A1c levels measured at 12 months. Blood pressure was a secondary outcome; levels of physical activity were determined by pedometer readings; depression, coping, and health-related quality of life were measured using standardized scales. RESULTS: Baseline A1c levels were relatively good and there was no difference in A1c at follow-up. Intervention patients experienced a 4.26 mmHg decrease in systolic blood pressure relative to controls (p = 0.05). Intervention patients had significantly greater increases in step counts (mean difference 1,131 steps/d; p = 0.0002) and greater reductions in depressive symptoms (58% remitted at 12 mo versus 39%; p = 0.002). Intervention patients also experienced relative improvements in coping and health-related quality of life. CONCLUSIONS: This program of telephone-delivered CBT combined with a pedometer-based walking program did not improve A1c values, but significantly decreased patients' blood pressure, increased physical activity, and decreased depressive symptoms. The intervention also improved patients' functioning and quality of life.

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