Oral Presentation Australian Diabetes Society and the Australian Diabetes Educators Association Annual Scientific Meeting 2016

Online depression treatment for people living with diabetes: randomised controlled trial findings (#113)

Jill Newby 1 2 , Lisa Robins 1 3 4 , Kay Wilhelm 1 4 , Jessica Smith 2 , Therese Fletcher 4 , Inika Gillis 4 , Trevor Ma 3 , Adam Finch 3 , Lesley Campbell 5 , Jerry Greenfield 5 , Gavin Andrews 1 2
  1. School of Psychiatry, Faculty of Medicine, UNSW, Kensington, NSW, AUstralia
  2. CRUfAD, St Vincent's Hospital Sydney, Darlinghurst, NSW, Australia
  3. Consultation Liaison Psychiatry, St Vincent's Hospital, Darlinghurst, NSW, Australia
  4. Faces in the Street, St Vincent's Hospital Sydney, Darlinghurst, NSW, Australia
  5. Diabetes Centre, St Vincent's Hospital, Darlinghurst, NSW, Australia

Background: Comorbid depression and diabetes (DM) are associated with poorer quality of life, poorer self-management and glycemic control, higher health service utilization, increased risk for DM complications and higher mortality rates. Depression remains under-recognized and undertreated in people with DM, which may, in part, result from barriers associated with accessing face-to-face treatment. Cost—effective and accessible forms of depression treatment need to be developed and evaluated. 

Objective: To examine the efficacy of a 6-lesson internet-based Cognitive Behavioural Therapy program for Major Depressive Disorder (iCBT-MDD) in people with Diabetes Mellitus (DM).

Research Design and Methods: Participants with comorbid MDD and DM (Type 1 or 2) were randomly allocated to the intervention (iCBT-MDD) versus a treatment as usual control group who received the iCBT-MDD program after 10 weeks. Primary outcomes were self-reported depression (PHQ-9), DM-related distress (PAID) and self-reported glycaemic control (HbA1c). Secondary outcomes were general distress (K10) and disability (SF-12), generalised anxiety (GAD-7),  somatisation, eating habits, alcohol use (PHQ modules), and lifestyle behaviours. The iCBT group was also assessed at 3-months to explore outcomes.

Results: Participants in the iCBT condition showed significant reductions between baseline and post-treatment in the primary measures of depression (PHQ9; Cohen’s d=1.68, 95%CIs = 1.19-2.17) and PAID (Cohen’s d=1.63, 95%CIs=0.09-1.26). Analyses indicated between-group superiority of iCBT over TAU on the primary and secondary outcome measures at post (Hedges g’s =.75-1.01, 95%CIs=.23-1.54). Gains were maintained at follow-up; evidence of relapse in the iCBT group will be discussed. Clinically significant change following iCBT on PHQ-9 scores was 47% vs. 12% in TAU. The majority of iCBT participants (84%) no longer met diagnostic criteria for depression at 3-month follow-up.

Conclusions: iCBT for depression is an efficacious, low-cost, accessible treatment option for people with diabetes. Future studies should explore whether tailoring of iCBT programs improves acceptability and adherence, and evaluate the long-term outcomes.