Endocrine Abstracts

Introduction and aim: Depression has a strong impact on psychosocial as well as medical outcomes in patients with diabetes. Consequently, depression treatment in diabetes is also aimed at improvement of glycemic control and reduction of diabetes complications and mortality risk\. Up to now, no single treatment that consistently leads to better medical outcomes in patients with both depression and diabetes has been clearly identified.

Matherial and methods: Patient was a 61 year old male worker, married. He has low educational and socioeconomic status and has been treated for type 2 diabetes with oral anti-diabetics for 10 years. The predictors of depression were longer duration of diabetes, low social support and unemployment. Due to high glycemic values in daily profile and HbA1c 9.8% for the past 3 months, intensified insulin therapy was started, but was not regularly monitored. Fifteen days before he was admitted to the Clinic for Psychiatry, University Clinical Center of the Republic of Srpska, he became irritable, overwhelming, troubled by small things, complained of malaise, loss of energy and strength. On admission the following symptoms are present psychiatric interview was done; psychological, somatic and neurological status;routine laboratory tests with the daily glycemic profile and HbA1c; EEG; psychological testing; Beck’s Depression Assessment Scale showed score of 57.

Results: Because of high glycaemic levels endocrinologist was adjusted insulin and antihypertensive therapy. Psychiatric condition stabilized on applied treatment and improvement of glycoregulation. The score on Beck’s scale was reduced to 12, and he was discharged with recommendations for follow ups with endocrinologists and psychiatrists. Selective serotonin reuptake inhibitors, antipsychotics in low doses, anxiolytic and psychotherapy was used. Treatment according to endocrinologist’s suggestion Structured education program “Düsseldorf model” After structured education HbA1c levels decreased by 1.8% after 6 months (9, 8 to 8, 0%) and by 1.2% after 12 months, compared to initial levels (9, 8 to 8, 6%) The score on Beck’s scale was reduced from 57 to 12, and patient was discharged with recommendations for follow ups with endocrinologists and psychiatrists.

Conclusion: It could be concluded that presence of depression is likely predictor of poor metabolic control of diabetes. Structured education program is efficient in improving glycaemic control in patients with type 2 diabetes. It motivates patients in achieving better glycaemia control. There is a decline in motivation after 12 months resulting in glycoregulation impairment and need for re-education at least once a year.