This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. Depressive symptomatology and diagnosis of depressive disorders are associated with worse diabetes control. Low-income minority populations have higher rates of depression and worsened diabetes control; as a result, they also suffer from disproportionate complications, morbidity, and mortality. In a recent report, patients with dual diagnoses of depression and diabetes had higher mortality rates, complication rates, and increased disability. Yet, treatment of mild-to-moderate depression has not been shown to improve glucose control in patients with diabetes. Few studies exist in treating depression in diabetic patients, and no published studies exist in depression treatment with low-income, underserved diabetic populations. The purpose of this study, The Effects of Pharmacologic Treatment of Depression on Glycated Hemoglobin and Quality of Life in Underserved Hispanics and African Americans with Diabetes; A Randomized, Placebo Controlled Trial, is to determine whether treatment for mild to-moderate depression in diabetic Hispanics and African Americans improves HBA1c, lipids, and quality of life. This study will test the following hypothesis: Pharmacologic treatment for mild-to-moderate depression in Hispanics and African Americans with diabetes will improve their HbA1c (and other metabolic parameters such as fasting lipid panel) and quality of life while on intervention in comparison to standard care. The hypothesis will be tested by the following specific aims: 1.To determine if treating mild to moderate depression with sertraline in patients with diabetes improves HbA1c in comparison to non-pharmacologic treatment. 2.To determine if treating mild to moderate depression with sertraline in patients with diabetes improves quality of life in comparison to non-pharmacologic treatment. This study is critical in that it may advance new treatment strategies for improving HbA1c (and other metabolic parameters such as lipids) and quality of life of our underserved minority community, which sadly suffers from a higher rate of almost every chronic disease, including diabetes. Treating depression in these populations not only will improve quality of life, but also may prevent diabetes complications, and depression resulting in early morbidity and premature death. Secondary outcomes also might include reduced hospitalizations, fewer missed appointments, and improved adherence to medication in this population, which has disproportionately high rates of diabetes mellitus.
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