Treatment adherence and wellness, nutrition, and physical activity outcomes of diabetic patients with comorbid depression during the 18-month follow-up of the TELE-DD study.

BACKGROUND: A good adherence to pharmacological treatment in chronic pathologies such as type 2 diabetes and clinical depression is essential to improve illness prognosis. AIMS: The main goal of the TELE-DD study was to analyze the effectiveness of a telephone, psychoeducational, and individualized intervention carried out by nurses in patients with type 2 diabetes mellitus and comorbid clinical depression with prior nonadherence to pharmacological treatment. In this paper, we describe and analyze secondary outcomes of the trial intervention. METHODS: A prospective cohort study was used to assess the effectiveness of a telephonic intervention (IG) in n = 191 participants with a similar control group (CG). Adherence to pharmacological treatment was assessed using the patient's self-perceived adherence questionnaire. In addition to clinical (HbAc1, HDL, LDL), physical (body mass index, blood pressure) and psychological measures (Patient Health Questionnaire-9 affective state), and psychosocial distress due to Diabetes Distress Scale Questionnaire at 3, 6, 12, and 18 months of follow-up were also analyzed. RESULTS: The proportion of "Total Adherents" in the IG was higher throughout the study. This was particularly true at month 18 of the intervention. Self-perceived adherence rates increased by 27.1% in the IG and by 1.1% in the CG. Results of clinical and physical measures were higher in the IG than in the CG at month 18 of the intervention. LINKING EVIDENCE TO ACTION: The interview based on positive reinforcement as well as individualized attention and flexibility in making telephone calls and dissemination of the intervention in the media closest to the patients were key to achieving good participation and collaboration as well as continuity in adherence to treatment and self-care.

The TELE-DD project on treatment nonadherence in the population with type 2 diabetes and comorbid depression.

Diabetic patients have increased depression rates, diminished quality of life, and higher death rates due to depression comorbidity or diabetes complications. Treatment adherence (TA) and the maintenance of an adequate and competent self-care are crucial factors to reach optimal glycaemic control and stable quality of life in these patients. In this report, we present the baseline population analyses in phase I of the TELE-DD project, a three-phased population-based study in 23 Health Centres from the Aragonian Health Service Sector II in Zaragoza, Spain. The objectives of the present report are: (1) to determine the point prevalence of T2D and clinical depression comorbidity and treatment nonadherence; (2) to test if HbA1c and LDL-C, as primary DM outcomes, are related to TA in this population; and (3) to test if these DM primary outcomes are associated with TA independently of shared risk factors for DM and depression, and patients' health behaviours. A population of 7,271 patients with type-2 diabetes and comorbid clinical depression was investigated for inclusion. Individuals with confirmed diagnoses and drug treatment for both illnesses (n = 3340) were included in the current phase I. A point prevalence of 1.9% was found for the T2D-depression comorbidity. The prevalence of patients nonadherent to treatment for these diseases was 35.4%. Multivariate analyses confirmed that lower diabetes duration, increased yearly PCS visits, HbA1c and LDL-C levels were independently related to treatment nonadherence. These findings informed the development of a telephonic monitoring platform for treatment of nonadherence for people with diabetes and comorbid depression and further trial, cost-effectiveness, and prognostic studies (phases II and III).