Depressive symptoms confound diabetes prevention efforts
medwireNews: The effectiveness of interventions to increase objectively measured physical activity in people at high risk for developing type 2 diabetes declines in line with symptoms of depression within the normal range, say researchers.
“Therefore, diabetes prevention programs should consider broadening their content to include a focus on depression as a core aim,” write Thomas Yates (University of Leicester, UK) and team in Diabetes Care.
“Simple tools—like HADS [Hospital Anxiety and Depression Scale], used in this study—are available to help identify those who would benefit most from such an approach.”
The median HADS score was 3 among 1163 people with or at high risk for elevated glucose levels, who participated in two primary care-based preventive programs. Although the two interventions differed in some respects, the physical activity elements, which were “based on personalized goal setting and pedometer use,” were “very similar,” say Yates et al.
The team found that each 1-point increase in baseline depressive symptoms was associated with a significant 88 steps per day reduction in the boost that the intervention gave to participants’ physical activity.
Likewise, each 1-point increase in depressive symptom score during follow-up was associated with an additional 99 steps per day reduction in the effectiveness of the intervention.
Importantly, the effect extended down into the “normal” range of symptoms, below the 8-point HADS cutoff at which people are considered to have mild clinical depression. Indeed, the benefits of the interventions disappeared at a score of 7; a person with a baseline score of 0 would achieve an additional average of 592 steps per day as a result of the intervention, but a score of 3 reduced this to 328 steps and a score of 7 entirely abolished the effect of the intervention.
The researchers believe that an additional 500 steps/day “could be considered clinically meaningful,” meaning that a score of just 3 – the average for the cohort – prevents people from achieving this goal.
They say the HADS scores in their study cohort are “consistent with normative HADS data from primary care in England,” and observe that “considering the average levels of depressive symptoms observed in this cohort, a general focus on depression within diabetes prevention may benefit the majority of those referred.”
And the team stresses that “because changes in the depressive symptom score were also associated with the intervention effect, the majority would achieve a clinically meaningful increase in physical activity if depressive symptoms were reduced by at least two, which is potentially achievable through simple cognitive-behavioral interventions.”
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