Aims

To evaluate the long-term effects of behavioral treatments on glycemic and psychological outcomes for patients with major depressive disorder (MDD) and type 2 diabetes (T2D).

Methods

Program ACTIVE II was a multicenter randomized controlled comparative effectiveness trial of cognitive behavioral therapy (CBT), exercise (EXER), combination treatment (CBT + EXER) and usual care (UC) for adults with MDD and T2D.

Results

Primary outcomes: change in A1c and depressive symptoms at 6- (N = 87) and 12-months (N = 75) from baseline. In those with a baseline A1c ≥7.0 %, CBT + EXER showed lasting A1c benefit at 6- (−1.2 %; SE: 0.6; p = 0.032) and 12-months (−1.4 %; SE: 0.6; p = 0.025) compared to UC. All groups had clinically significant improvements in depressive symptoms. At 6 months, CBT + EXER had significant improvements in diabetes-related distress regimen burden (p = 0.005); and social support (CIRS, p = 0.043) compared to UC.

Conclusions

The Program ACTIVE II CBT + EXER intervention demonstrated a sustained improvement in A1c for a subgroup of study participants with a baseline A1c ≥7.0 %. However, this finding should be considered preliminary because of small sample size. All 3 behavioral intervention groups demonstrated improvements in psychosocial outcomes one-year post-intervention. These findings point to the enduring benefits of community-based interventions to extend the availability of depression treatment for T2D patients.

中文翻译：

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ACTIVE II 计划：成人 2 型糖尿病重度抑郁症治疗方法的 6 个月和 12 个月结果

目标

评估行为治疗对重度抑郁症 (MDD) 和 2 型糖尿病 (T2D) 患者血糖和心理结果的长期影响。

方法

ACTIVE II 计划是一项针对成人 MDD 和 T2D 的认知行为疗法 (CBT)、运动 (EXER)、联合治疗 (CBT + EXER) 和常规护理 (UC)的多中心随机对照比较有效性试验。

结果

主要结局：自基线起 6 个月（N = 87）和 12 个月（N = 75）时 A1c 和抑郁症状的变化。对于基线 A1c ≥7.0 % 的患者，CBT + EXER 在 6 个月（−1.2 %；SE：0.6；p = 0.032）和 12 个月（−1.4 %；SE：0.6；p = 0.025）时显示出持久的 A1c 益处。与UC相比。所有组的抑郁症状都有临床显着改善。6 个月时，CBT + EXER 显着改善了糖尿病相关的应激治疗负担 (p = 0.005)；与 UC 相比，社会支持（CIRS，p = 0.043）。

结论

ACTIVE II CBT + EXER 干预计划表明，基线 A1c ≥7.0 % 的研究参与者亚组的 A1c 持续改善。然而，由于样本量较小，这一发现应被视为初步结果。所有 3 个行为干预组在干预一年后均表现出心理社会结果的改善。这些发现表明，以社区为基础的干预措施对于扩大 T2D 患者抑郁症治疗的可及性具有持久的益处。