Behavioral Medicine, Clinical Nutrition, Education, and Exercise

Depression without meeting the criteria of a major depression. However, elevated depressive symptoms are associated with a reduced quality of life, lower self-care activities, and a higher mortality. To target this large group of people, a diabetes-specific treatment program (DIAMOS) was developed and evaluated in a randomized controlled trial with a 12-month follow-up. DIAMOS is a group program based on cognitive-behavioral-therapy (CBT). It consists of 5 group sessions which lasts for 90 minutes each. 214 inpatients with subclinical depression were randomized either to DIAMOS or to a control group receiving diabetes education. Depression, diabetesrelated distress, and quality of life were assessed via questionnaires (CES-D, PAID, WHO-5 respectively). HbA1c was analyzed in a central laboratory. 181 patients (age: 45±14 yrs.; 57% female; 63% Type 1 DM; diabetes duration 15±11 yrs.; 95% with insulin; 51% with late complications; HbA1c 8.8±1.7%; CES-D 23.3±8.1; PAID 39.5±18.4; WHO-5 8.9±4.5) were available at the 12-month follow-up (drop-out rate: 15%). Compared to the control group, patients treated with DIAMOS showed a significantly greater reduction of depressive symptoms (- 7.4 ± 11.4 vs. - 2.7 ± 11.7; p < .01), and diabetes-related distress (- 13.0 ± 18.9 vs. - 4.2 ± 16.9; p < .01), as well as a significantly greater improvement of quality of life (+ 4.5 ± 6.1 vs. + 2.5 ± 6.3; p = .03). HbA1c improvement was comparable in both groups. The results demonstrate that DIAMOS is an effective tool for the treatment of subclinical depression in people with diabetes. In addition, DIAMOS positively affects diabetes-related distress and quality of life. Interestingly, the reduction of depressive symptoms and distress was not associated with an improvement of glycemic control. DIAMOS proofs to be an innovative tool for routine care to improve the situation of people with diabetes and subclinical depression.