Primary care diabetes prevention programs that promote physical activity become less effective when patients experience depressive symptoms, according to study results published in Diabetes Care.
To determine whether the effects of diabetes prevention programs in primary care settings are reduced if patients have depression or anxiety, researchers conducted 2 trials of individuals at high risk for type 2 diabetes. Included patients (N=1163) were recruited from primary care practices and randomly assigned to a control (n=571) or intervention program (n=592).
The researchers measured depressive symptoms using the Hospital Anxiety and Depression Scale (scale of 0-21) and physical activity (steps per day) with piezoelectric pedometers in one study and an accelerometer in the other. Both trials similarly promoted physical activity in the intervention groups and followed up with patients over 3 years.
Median depressive symptom score was 3 at baseline. In total, 11% of all participants were categorized as mildly or severely depressed (score ≥8). In individuals without any depressive symptoms at baseline or during follow-up, ambulatory activity increased by an average of 592 steps per day (P <.001), a clinically meaningful improvement in ambulatory activity according to the investigator’s criteria. Each additional depressive symptom score at baseline yielded a loss of 88 steps per day, and each increase in score between baseline and follow-up further reduced the effect by 99 steps per day.
Of note, the study was limited in that 31% of participants did not have concurrent baseline and follow-up data, which may have introduced bias.
In summarizing their findings, the researchers said, “diabetes prevention programs should consider broadening their content to include a focus on depression as a core aim. Simple tools [like the Hospital Anxiety and Depression Scale] are available to help identify those who would benefit most from such an approach. However, 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.”
Yates T, Gray LJ, Henson J, Edwardson CL, Khunti K, Davies MJ. Impact of depression and anxiety on change to physical activity following a pragmatic diabetes prevention program within primary care: pooled analysis from two randomized controlled trials [published online August 9, 2019]. Diabetes Care. doi:10.2337/dc19-0400