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      Effectiveness of a Multifactorial Cardiovascular Risk Reduction Clinic for Diabetes Patients with Depression

      research-article
      , MD, MPH , , MD, , PharmD, , PharmD
      Preventing Chronic Disease
      Centers for Disease Control and Prevention

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          Abstract

          Introduction

          Depression may attenuate the effects of diabetes interventions. Our ongoing Cardiovascular Risk Reduction Clinic simultaneously addresses hyperglycemia, hypertension, smoking, and hyperlipidemia. We examined the relationship between depression diagnosis and responsiveness to the Cardiovascular Risk Reduction Clinic.

          Methods

          We studied Cardiovascular Risk Reduction Clinic participants with diabetes who had a depression diagnosis and those with no mental health diagnosis. Our outcome measure was change in 20-year cardiovascular mortality risk according to the United Kingdom Prospective Diabetes Study (UKPDS) score.

          Results

          Of 231 participants, 36 (15.6%) had a depression diagnosis. Participants with a depression diagnosis had a higher baseline UKPDS score (56.8 [SD 21.3]) than participants with no mental health diagnosis (49.5 [SD 18.7], P = .04). After Cardiovascular Risk Reduction Clinic participation, mean UKPDS scores did not differ significantly (37.8 [SD 15.9] for no mental health diagnosis and 39.4 [SD 18.6] for depression diagnosis). Mean UKPDS score reduction was 11.6 [SD 15.6] for no mental health diagnosis compared with 18.4 [SD 15.9] for depression diagnosis ( P = .03). Multivariable linear regression that controlled for baseline creatinine, number of Cardiovascular Risk Reduction Clinic visits, sex, and history of congestive heart failure showed significantly greater improvement in UKPDS score among participants with a depression diagnosis (β = 6.0, P = .04) and those with more Cardiovascular Risk Reduction Clinic visits (β = 2.1, P < .001).

          Conclusion

          The Cardiovascular Risk Reduction Clinic program reduced cardiovascular disease risk among patients with diabetes and a diagnosis of depression. Further work should examine how depressive symptom burden and treatment modify the effect of this collaborative multifactorial program and should attempt to determine the durability of the effect.

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          Most cited references17

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          Case-finding instruments for depression. Two questions are as good as many.

          To determine the validity of a two-question case-finding instrument for depression as compared with six previously validated instruments. The test characteristics of a two-question case-finding instrument that asks about depressed mood and anhedonia were compared with six common case-finding instruments, using the Quick Diagnostic Interview Schedule as a criterion standard for the diagnosis of major depression. Urgent care clinic at the San Francisco Department of Veterans Affairs Medical Center. Five hundred thirty-six consecutive adult patients without mania or schizophrenia. Measurements were two questions from the Primary Care Evaluation of Mental Disorders patient questionnaire, both the long and short forms of the Center for Epidemiologic Studies Depression Scale, both the long and short forms of the Book Depression Inventory, the Symptom-Driven Diagnostic System for Primary Care, the Medical Outcomes Study depression measure, and the Quick Diagnostic Interview Schedule. The prevalence of depression, as determined by the standardized interview, was 18% (97 of 536). Overall, the case-finding instruments had sensitivities of 89% to 96% and specificities of 51% to 72% for diagnosing major depression. A positive response to the two-item instrument had a sensitivity of 96% (95% confidence interval [CI], 90-99%) and a specificity of 57% (95% CI 53-62%). Areas under the receiver operating characteristic curves were similar for all of the instruments, with a range of 0.82 to 0.89. The two-question case-finding instrument is a useful measure for detecting depression in primary care. It has similar test characteristics to other case-finding instruments and is less time-consuming.
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            The UKPDS risk engine: a model for the risk of coronary heart disease in Type II diabetes (UKPDS 56).

            A definitive model for predicting absolute risk of coronary heart disease (CHD) in male and female people with Type II diabetes is not yet available. This paper provides an equation for estimating the risk of new CHD events in people with Type II diabetes, based on data from 4540 U.K. Prospective Diabetes Study male and female patients. Unlike previously published risk equations, the model is diabetes-specific and incorporates glycaemia, systolic blood pressure and lipid levels as risk factors, in addition to age, sex, ethnic group, smoking status and time since diagnosis of diabetes. All variables included in the final model were statistically significant (P<0.001, except smoking for which P=0.0013) in likelihood ratio testing. This model provides the estimates of CHD risk required by current guidelines for the primary prevention of CHD in Type II diabetes.
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              Measuring degree of physical dependence to tobacco smoking with reference to individualization of treatment.

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                Author and article information

                Contributors
                Program to Integrate Psychosocial and Health Services in Chronic Diseases and Disability, Providence Veterans Affairs Medical Center
                ,
                Program to Integrate Psychosocial and Health Services in Chronic Diseases and Disability, Providence Veterans Affairs Medical Center and Warren Alpert Medical School of Brown University, Providence, Rhode Island
                Program to Integrate Psychosocial and Health Services in Chronic Diseases and Disability, Providence Veterans Affairs Medical Center and Department of Pharmacy Practice, College of Pharmacy, University of Rhode Island, Kingston, Rhode Island
                Program to Integrate Psychosocial and Health Services in Chronic Diseases and Disability, Providence Veterans Affairs Medical Center and Department of Pharmacy Practice, College of Pharmacy, University of Rhode Island, Kingston, Rhode Island
                Journal
                Prev Chronic Dis
                Preventing Chronic Disease
                Centers for Disease Control and Prevention
                1545-1151
                October 2008
                15 September 2008
                : 5
                : 4
                : A127
                Affiliations
                Program to Integrate Psychosocial and Health Services in Chronic Diseases and Disability, Providence Veterans Affairs Medical Center
                Program to Integrate Psychosocial and Health Services in Chronic Diseases and Disability, Providence Veterans Affairs Medical Center and Warren Alpert Medical School of Brown University, Providence, Rhode Island
                Program to Integrate Psychosocial and Health Services in Chronic Diseases and Disability, Providence Veterans Affairs Medical Center and Department of Pharmacy Practice, College of Pharmacy, University of Rhode Island, Kingston, Rhode Island
                Program to Integrate Psychosocial and Health Services in Chronic Diseases and Disability, Providence Veterans Affairs Medical Center and Department of Pharmacy Practice, College of Pharmacy, University of Rhode Island, Kingston, Rhode Island
                Article
                PCDv54_07_0167
                2578763
                18793515
                ed213efa-63c6-4b48-b2a2-dbcb88d6293b
                Copyright @ 2008
                History
                Categories
                Original Research
                Peer Reviewed

                Health & Social care
                Health & Social care

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