A Randomized Trial of Telephonic Counseling Plus Walking for Depressed Diabetes Patients
A Randomized Trial of Telephonic Counseling Plus Walking for Depressed Diabetes Patients
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DOI：
10.1097/mlr.0b013e318215d0c9
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发表时间：
2011-07-01
期刊：
影响因子：
3
通讯作者：
Valenstein, Marcia
中科院分区：
文献类型：
--
作者：
Piette, John D.;Richardson, Caroline;Valenstein, Marcia
背景：糖尿病和抑郁症患者往往有自我管理的需求，需要访问之间的支持。本研究评估了电话传递认知行为疗法（CBT）的影响，针对患者的抑郁症状，体力活动水平和糖尿病相关outcome.Methods的管理：291例2型糖尿病和显着的抑郁症状（贝克抑郁量表评分>= 14）被招募从社区为基础的，大学为基础的，退伍军人事务部的医疗保健系统。护士每周提供一次手动电话CBT计划，持续12周，然后每月进行9次助推器会议。Sessions最初专注于患者的抑郁管理，然后增加了基于计步器的步行计划。主要结局是12个月时测量的血红蛋白A1 c水平。血压是一个次要的结果;体力活动水平由计步器读数确定;抑郁症，应对，和健康相关的生活质量进行了测量，使用标准化scales.Results：基线A1 C水平相对较好，并没有在随访A1 C的差异。与对照组相比，干预组患者收缩压降低4.26 mm Hg（P = 0.05）。干预组患者的步数显著增加（平均差异为1131步/d; P = 0.0002），抑郁症状显著减少（12个月时缓解率为58% vs. 39%; P = 0.002）。干预患者也经历了相对改善应对和健康相关的quality of life.Conclusions：这个程序的电话提供CBT结合计步器为基础的步行程序并没有提高A1 C值，但显着降低患者的血压，增加体力活动，并减少抑郁症状。干预还改善了患者的功能和生活质量。
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 mm Hg decrease in systolic blood pressure relative to controls (P = 0.05). Intervention patients had significantly greater increases in step counts (mean difference, 1131 steps/d; P = 0.0002) and greater reductions in depressive symptoms (58% remitted at 12 mo vs. 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.