Aims

Elevated depressive symptoms are common among adults with type 2 diabetes (T2D). In a secondary analysis from an RCT of a diabetes self-management support intervention that did not target depressive symptoms, we sought to determine if depressive symptoms were reduced by the intervention (i.e., depressive symptoms an outcome) or, alternatively, if intervention effects on hemoglobin A1c were lesser among persons with clinically elevated depressive symptoms (i.e., depressive symptoms an effect modifier).

Methods

We evaluated a text messaging intervention, REACH, in a diverse (half non-white, half underinsured) sample of N = 506 adults with T2D. Participants completed the Patient Health Questionnaire-8 (PHQ) and A1c tests at baseline and 6 months. We conducted a factor analysis to identify somatic- and cognitive-affective symptoms on the PHQ. We tested our hypotheses with regression models, using interaction terms and subgroup analyses.

Results

REACH improved depressive symptoms among participants with lower baseline A1c (<8.5%; β = −0.133, p = .007; cognitive β = −0.107, p = .038; somatic β = −0.131, p = .014) but not among participants with higher baseline A1c (≥8.5%; β = 0.040, p = .468). Baseline depressive symptoms did not modify the effect on A1c.

Conclusions

We found support for the hypothesis that depressive symptoms – both somatic- and cognitive-affective – may be an outcome, rather than an effect modifier, of effective diabetes self-management support interventions.

中文翻译：

---

无论抑郁症状如何，2 型糖尿病成人患者都可以从自我管理支持干预中受益

目标

抑郁症状加重在 2 型糖尿病 (T2D) 成人患者中很常见。在对不针对抑郁症状的糖尿病自我管理支持干预措施的随机对照试验进行的二次分析中，我们试图确定干预措施是否减少了抑郁症状（即抑郁症状作为结果），或者干预措施是否对抑郁症状产生影响。临床上抑郁症状升高（即抑郁症状是一种效应调节剂）的人中，血红蛋白 A1c 较低。

方法

我们在 N = 506 名患有 T2D 的成年人的不同样本（一半非白人，一半保险不足）中评估了短信干预措施 REACH。参与者在基线和 6 个月时完成了患者健康问卷 8 (PHQ) 和 A1c 测试。我们进行了因子分析，以确定 PHQ 上的躯体和认知情感症状。我们使用回归模型、交互项和亚组分析来测试我们的假设。

结果

REACH 改善了基线 A1c较低的参与者的抑郁症状（<8.5%；β = -0.133，p  = .007；认知 β = -0.107，p  = .038；躯体 β = -0.131，p  = .014），但没有改善基线 A1c 较高的参与者（≥8.5%；β = 0.040，p  = .468）。基线抑郁症状不会改变对 A1c 的影响。

结论

我们发现了以下假设的支持：抑郁症状（包括躯体情感和认知情感）可能是有效的糖尿病自我管理支持干预措施的结果，而不是效果调节剂。