Researchers at the Ann Arbor V.A. Healthcare System in Flint, Michigan evaluated the impact of telephone-delivered cognitive behavioral therapy (CBT) targeting diabetic patients' management of depressive symptoms, physical activity levels, and diabetes-related outcomes.  Concern about the need for between-visit support in this population was what generated this study.  

Two hundred ninety-one patients with type 2 diabetes and significant depressive symptoms (Beck Depression Inventory scores ≥ 14) were recruited from 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.

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.

The evaluators concluded that 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.

Citation:  Piette JD, Richardson C, Himle J, Duffy S, Torres T, Vogel M, Barber K, Valenstein MA randomized trial of telephonic counseling plus walking for depressed diabetes patients. Medical Care. 2011 Jul;49 (7): pages 641-8. [email protected]