Endocrine Abstracts

Introduction: In patients with type 1 diabetes (T1D), depression increases the risk for persistent hyperglycemia, diabetes complications and mortality. Most results demonstrated that depression is associated with nearly all important medical and psychosocial outcome parameters of T1D. Also, it has been demonstrated that poor diabetes self-care can result from patients’ lack of knowledge or existing psychosocial issues, primarily depression. The aim of the study was to determine: the presence of depressionin patients with T1D and its impact on the level of HbA1c; impact of structured education program on the level of patients knowledgeabout T1D and level of depression.

Methods: The study included 38 patients with T1D. For assessment of the level of depression the Zung Self-Rating Depression Scale (ZSDS) and Beck’s Depression Assessment Scale (BDI) was used, as well as questionnaire on knowledge about diabetes and self–control. Structureeducation program-‘Düsseldorf model‘ of 5 day duration was applied and conducted in the day hospital Clinical centre of Banjaluka. All patients had HbA1c measured at the beginning of the education and at 3, 6, 9 and 12 month follow-up.

Results: Based on the ZSDS, 36 patients (94.7%) had depression, 20 (52.6%) had clinically significant level of depression, 16 (42.1%) showed mild symptoms of depression and 2 (5.2%) patients showed no symptoms of depression (P<0.001). In the group with depression ofdiabetic patients, 65% had unsatisfactory level of glycoregulation (HbA1c 9.8%). After education, HbA1c levels decreased by 1.8% after 6 months, and 1.2% after 12 months compared to initial levels (P<0.005). Results of test knowledge about T1D hasshown that patients improved their knowledge for 36.78%(P<0.005) after education. BDI showed a score of 57 at thebeginning of examination and score was reduced to12 at the end of examination (P<0.005).

Conclusion: Up to now, no single treatment that consistently leads to better medical outcomes in patients with both depression and T1D has been clearly identified. Structured educational program and functional insulin therapy are efficient in improving glycemic control in patients with T1D and depression. It motivates patients in achieving better glycaemic control and beter deprresion score. Thus, the main role of diabetes team is to assess the disease course, to educate and provide psychosocial support in order for the patient to make decisions about their daily self-care and self-control.