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Would cognitive behavioural therapy in conjunction with routine diabetic treatment be more efficient in managing depression in patients with Type 2 diabetes than routine treatment alone?

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Introduction

Would cognitive behavioural therapy in conjunction with routine diabetic treatment be more efficient in managing depression in patients with Type 2 diabetes than routine treatment alone? Introduction The essay presented below is aimed at finding evidence-based answer to my question: "Would cognitive behavioural therapy (CBT) in conjunction with routine diabetic treatment be more efficient in managing depression in patients with Type 2 diabetes than routine treatment alone?" It also involves the critical appraisal of a study which has tried to answer the above question, followed by the systematic review of 5 articles closely related to the topic. The aim of this essay is to investigate whether psychological interventions in diabetic patients with depression are effective in improving clinical outcomes. When looking into the medical treatment given to diabetic patients nationwide in the UK, I came across several non-pharmacological therapies that could improve the patients' adherence and control over their condition. The efficacy and the cost effectiveness of such therapies combined with usual treatment appeared to be an interesting topic to investigate. I have narrowed down the available therapies and specified my systematic literature search on Cognitive Behaviour Therapy, as its use in the management of depression in diabetes has recently become more popular in the UK and in other countries. Diabetes is showing a steadily growing incidence globally, the occurrence of diabetes among adults was around 6.4% in 2010, reaching 7.7% by 2030. 9% of patients with diabetes also suffer from depressive disorders (Petrak et al. 2010), which in turn leads to poor treatment adherence and hyperglycaemia. The risk of developing cardiovascular disease and retinopathy is greater in patients who have depression. ...read more.

Middle

and a guided self-help intervention (SH). Treatment evaluations are conducted by blinded assessors. As clearly identifiable group interventions were compared to treatment as usual, further blinding is not possible. The randomisation process does not open to manipulation from the researchers or the participants thus reducing bias. The aim is to compare the efficacy of the 3 different treatments. Primary and secondary parameters are aiming to reduce depressive symptoms, prevent the occurrence of moderate/severe major depression and improve glycaemic control, mortality and cost effectiveness. The measures being used to determine the outcome of the trial are fitting for a quantitative study. Participants are randomised into groups as: 132 in CBT (diabetes-specific CBT in small groups of 4-8, delivered by psychologists), 132 in SH (guided self-help intervention "Successful ageing with Diabetes", delivered by trained moderators), and 51 in TAU (any treatment option may be applicable). Patients in all groups are having usual diabetic treatment for the first 12 weeks. Thereafter, the two group interventions are receiving one session per month for another year. At the one-year check-up, all groups are being examined as to the primary and secondary outcome variables. A 20% rate of loss to follow-up is expected, accounting for mortality in the sample. All sessions are videotaped and supervised by psychotherapists. Analyses are carried out by the intent-to-treat principle (ITT) including all participants in all groups. In case of any dropouts, the last observation carried forward method (LOCF) will be used in purpose of handling of missing data. The primary outcome variable is HRQoL as measured by the Short Form-36 Mental Component Summary. ...read more.

Conclusion

This study clearly suggests though, that CBT can be effectively applied for the treatment of depression in Type 2 diabetes patients. The evidence found in the above articles indicates that CBT can be successfully used for treatment of depression in Type 2 diabetes patients, and there is evidence that the application of CBT may reduce depressive symptoms and HbA1c. Nevertheless, future research should be done to provide sufficient statistical power and substantiate these preliminary findings. There is lack of clinical trials to support the statement that CBT in conjunction with routine diabetic care would be more efficient in treating depression in Type 2 diabetes than routine care alone. Conclusion The evidence gathered in the process of literature search and literature review backs up the theory that application of CBT when used in conjunction with routine diabetes care is useful in treatment of depression in patients with Type 2 diabetes. CBT seems to have relatively positive short-term results in improving both quality of life and glycaemic control of patients with Type 2 diabetes. However, there is still not enough evidence to state that CBT in conjunction with usual diabetic care would be more effective in treating depression in patients with Type 2 diabetes, which is due to limited research and few clinical trials conducted in the UK in this area. Further research is needed in order to work out the best approaches towards psychological counselling for patients with diabetes and depression. Nevertheless, the information found during the literature search process shows that CBT as additional care is obtaining popularity among patients and health professionals. A well-organised healthcare environment run by health-care professionals who are trained to provide CBT would be beneficial for patients with diabetes. ...read more.

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