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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/cdn\/css\/http\/css_Xg7z6oCTVgud_Q0huYz9x9iiD5H_2YPSJ5z2ZViSWdY.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EComorbid depression in diabetes is highly prevalent and has a negative impact on well-being and diabetes control [van der Feltz-Cornelis CM et al. \u003Cem\u003EGen Hosp Psychiatry\u003C\/em\u003E 2010]. Diabetes patients with comorbid depression are less likely to engage in physical activity, comply with dietary advice, and stop smoking [DiMatteo MR et al. \u003Cem\u003EArch Intern Med\u003C\/em\u003E 2000].\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EDiabetes Mellitus\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EMood Disorders\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EComorbid depression in diabetes is highly prevalent and has a negative impact on well-being and diabetes control [van der Feltz-Cornelis CM et al. \u003Cem\u003EGen Hosp Psychiatry\u003C\/em\u003E 2010]. Diabetes patients with comorbid depression are less likely to engage in physical activity, comply with dietary advice, and stop smoking [DiMatteo MR et al. \u003Cem\u003EArch Intern Med\u003C\/em\u003E 2000]. They have increased disease burden, greater symptom severity, and more work disability and make greater use of medical services [Lin E et al. \u003Cem\u003EDiabetes Care\u003C\/em\u003E 2010].\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EIn a longitudinal cohort study of 4623 primary care patients with type 2 diabetes mellitus (T2DM), major depression was associated with significantly higher risks of adverse microvascular (HR, 1.36; 95% CI, 1.05 to 1.75) and macrovascular outcomes (HR, 1.24; 1.0 to 1.54; \u003Ca id=\u0022xref-table-wrap-1-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T1\u0022\u003ETable 1\u003C\/a\u003E) [Lin EH et al. \u003Cem\u003EDiabetes Care\u003C\/em\u003E 2010]. Treatment of depression in people with diabetes is a necessary step, but improvement of their general medical condition, including glycemic control, is likely to require simultaneous attention to both conditions [van der Feltz-Cornelis CM et al. \u003Cem\u003EGen Hosp Psychiatry\u003C\/em\u003E 2010].\u003C\/p\u003E\u003Cdiv id=\u0022T1\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/12511\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/12511\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/12511\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 1.\u003C\/span\u003E \n            \u003Cp id=\u0022p-4\u0022 class=\u0022first-child\u0022\u003EHR (95% CIs) for Microvascular and Macrovascular Outcomes in Patients with Diabetes.\u003C\/p\u003E\n         \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-10\u0022\u003EAccording to Cristina van der Feltz-Cornelis, MD, PhD, MSc, University of Tilburg, Tilburg, The Netherlands, T2DM patients with depression need the awareness of the clinician and of mental health professionals; routine screening for depression; integrated, holistic, individualized care; medicines with the fewest number of side effects; information and psychoeducation; relapse prevention; and consultations with psychologists and diet specialists on a regular basis.\u003C\/p\u003E\u003Cp id=\u0022p-11\u0022\u003EPatients can be treated with psychotherapy that is combined with diabetes self-management, medications, or a combination of the two in the primary care setting. Dr. van der Feltz-Cornelis explained that among antidepressants, fluoxetine, sertraline, nortriptyline, and paroxetine significantly improve depressive symptoms. Fluoxetine helps with weight loss and lowers glucose and lipids. Sertraline is effective for relapse prevention, and sertraline and paroxetine improve comorbid anxiety, quality of life, and general functioning. Sertraline is the only antidepressant that influences glycemic control.\u003C\/p\u003E\u003Cp id=\u0022p-12\u0022\u003EValid instruments for screening include the gold-standard clinical interview, the Beck Depression Inventory (BDI) [Lustman PJ et al. \u003Cem\u003EPsychosom Med\u003C\/em\u003E 1997], Center for Epidemiological Studies-Depression Scale (CES-D), the Hospital Anxiety and Depressions Scale (HADS), the Silverstone Concise Assessment for Depression (SCAD), Depression in the Medically Ill Questionnaire (DMI) [McHale M et al. \u003Cem\u003EPsychosom Med\u003C\/em\u003E 2008], and the Patient Health Questionnaire-9 (PHQ-9) [van Steenbergen-Weijenburg KM et al. \u003Cem\u003EBMC Health Serv Res\u003C\/em\u003E 2010].\u003C\/p\u003E\u003Cp id=\u0022p-13\u0022\u003EFor depressed patients, screening alone plus information is insufficient treatment. Pouwer et al. [\u003Cem\u003EDiabetologia\u003C\/em\u003E 2011] found that depression screening by Composite International Diagnostic Interview plus information about the diagnosis made no significant difference in depression scores, diabetes outcomes, or health care utilization.\u003C\/p\u003E\u003Cp id=\u0022p-14\u0022\u003EScreening can be done with CES-D, BDI, or PHQ-9 (cutoff point \u226512 to find major depressive disorder) [van Steenbergen-Weijenburg KM et al. \u003Cem\u003EBMC Health Serv Res\u003C\/em\u003E 2010] and should be followed by a strong intervention that includes psychotherapy or medication (eg, collaborative care).\u003C\/p\u003E\u003Cp id=\u0022p-15\u0022\u003EDepressed patients who are willing and able to engage in treatment should be filtered out from those who are not. Motivational interviewing can be used to improve adherence by the latter. Effective care requires identification of symptoms of depression and appropriate treatment (\u003Ca id=\u0022xref-table-wrap-2-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T2\u0022\u003ETable 2\u003C\/a\u003E).\u003C\/p\u003E\u003Cdiv id=\u0022T2\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/12513\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/12513\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/12513\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 2.\u003C\/span\u003E \n            \u003Cp id=\u0022p-16\u0022 class=\u0022first-child\u0022\u003ERisk Profile and Treatment Indication.\u003C\/p\u003E\n         \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-18\u0022\u003EAdditional Reading: Van der Feltz-Cornelis et al. Depression in Diabetes Mellitus: to screen or not to screen? \u003Cem\u003EThe British Journal of Diabetes and Vascular Disease.\u003C\/em\u003E In Press. \u003Ca href=\u0022http:\/\/dvd.sagepub.com\u0022\u003Ehttp:\/\/dvd.sagepub.com\u003C\/a\u003E\n      \u003C\/p\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2011 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/11\/11\/29.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzmyb2\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_tables.js?nzmyb2\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}