Diabetes affects between 6.5 and 13 million Americans and is associated with an expenditure of over $44 billion in direct health care costs per year. Prevalence rates for Latinos, America's fastest growing minority, are approximately twice that of European-Americans (EAs). Depression occurs as a comorbid condition in 23% of EAs with diabetes, but the rate of depression among Latinos with diabetes is almost 30%. Depression is associated with decreased self-management behavior, poor metabolic control, and increased risk for complications. Explanatory models, based almost exclusively on cross-sectional research, suggest that depression has both direct and indirect effects on metabolic control through self-management. Disease severity, impairment, complications, life stress, personal resources, and social support also affect these relationships. Given the pervasiveness of depressive affect, the variability in self-management among EA and Latino patients with diabetes, and the increased behavioral and biological risk that depression poses for these patients, longitudinal studies with implications for intervention are needed to describe the forms that depression and self-management can take in these patients over time. The proposed 3-wave, 18-month longitudinal project seek to: (1) describe the variation, and sub group patterning of depression and self-management over time in EA and Latino patients with type 2 diabetes; (2) identify the linkages among depression, self-management, and metabolic control, over time, along with factors that moderate these linkages; and (3) determine variations in these relationships based on patient ethnicity (EAs, Latinos). The proposed longitudinal research has major implications for intervention: it will provide a more complete description of the natural course of the full range of major and minor depression and self-management over time, it will identify sub group variations that may warrant specific interventions, it will identify at what point along the continuum of depressive affect linkages with disease self-management and metabolic control become evident, and it will highlight differences in these relationships based on patient ethnicity.

Agency
National Institute of Health (NIH)
Institute
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Type
Research Project (R01)
Project #
5R01DK061937-04
Application #
7083508
Study Section
Special Emphasis Panel (ZRG1-RPHB-3 (01))
Program Officer
Hunter, Christine
Project Start
2003-07-01
Project End
2008-02-29
Budget Start
2006-07-01
Budget End
2008-02-29
Support Year
4
Fiscal Year
2006
Total Cost
$623,480
Indirect Cost
Name
University of California San Francisco
Department
Family Medicine
Type
Schools of Medicine
DUNS #
094878337
City
San Francisco
State
CA
Country
United States
Zip Code
94143
Fisher, Lawrence; Hessler, Danielle; Polonsky, William et al. (2018) Emotion regulation contributes to the development of diabetes distress among adults with type 1 diabetes. Patient Educ Couns 101:124-131
Hessler, Danielle; Fisher, Lawrence; Strycker, Lisa A et al. (2015) Causal and bidirectional linkages over time between depression and diabetes regimen distress in adults with type 2 diabetes. Diabetes Res Clin Pract 108:360-6
Glasgow, Russell E; Fisher, Lawrence; Strycker, Lisa A et al. (2014) Minimal intervention needed for change: definition, use, and value for improving health and health research. Transl Behav Med 4:26-33
Fisher, L; Gonzalez, J S; Polonsky, W H (2014) The confusing tale of depression and distress in patients with diabetes: a call for greater clarity and precision. Diabet Med 31:764-72
Fisher, L; Hessler, D; Masharani, U et al. (2014) Impact of baseline patient characteristics on interventions to reduce diabetes distress: the role of personal conscientiousness and diabetes self-efficacy. Diabet Med 31:739-46
Hessler, Danielle; Fisher, Lawrence; Glasgow, Russell E et al. (2014) Reductions in regimen distress are associated with improved management and glycemic control over time. Diabetes Care 37:617-24
Fisher, Lawrence; Hessler, Danielle; Glasgow, Russell E et al. (2013) REDEEM: a pragmatic trial to reduce diabetes distress. Diabetes Care 36:2551-8
Fisher, Lawrence; Hessler, Danielle M; Polonsky, William H et al. (2012) When is diabetes distress clinically meaningful?: establishing cut points for the Diabetes Distress Scale. Diabetes Care 35:259-64
Fisher, Lawrence; Hessler, Danielle; Naranjo, Diana et al. (2012) AASAP: a program to increase recruitment and retention in clinical trials. Patient Educ Couns 86:372-7
Gonzalez, Jeffrey S; Fisher, Lawrence; Polonsky, William H (2011) Depression in diabetes: have we been missing something important? Diabetes Care 34:236-9

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