Treating depression may help people with diabetes get their blood sugar under control.

In a study of low-income minorities with poorly controlled diabetes, researchers found that antidepressant therapy was associated with improved long-term blood sugar control and reduced blood pressure.

Rates of depression in people with diabetes are double those in the general population, and even higher among minorities, who are more prone to worse blood sugar control, more diabetes complications, and more severe depression, the researchers point out. Yet few studies have focused on the effect of depression treatment among minorities with uncontrolled diabetes.

To investigate, Dr. Mayer B. Davidson and his colleagues at Charles Drew University in Los Angeles screened low-income patients attending a diabetes clinic for depression.

Ultimately, the study included 89 patients; 45 were randomly assigned to receive the antidepressant medication sertraline (sold as Zoloft) and 44 to a placebo. Everyone in the study also attended monthly diabetes group education programs.

Thirty-nine patients in each group were Hispanic, five were African American, and 1 in the sertraline group was listed as other.

According to the investigators, after six months, blood sugar levels had fallen significantly in the sertraline group. That is, hemoglobin A1C levels, a standard measure of long-term blood sugar control, fell 2.0 percent, from 10.0 percent at the outset to 8.0 percent at six months. In general, it's recommended that people with diabetes strive for an A1C level below 7.0 percent.

In contrast, there was only a 0.9 percent drop in A1C levels in the placebo group (from 9.7 percent at the outset to 8.8 percent at six months).

Blood pressure also fell to a greater degree with sertraline than with placebo, while both groups had similar significant improvements in depression, pain and quality of life.

These results, the researchers say, suggest that patients with diabetes should be screened for depression. For those found to have depression, an antidepressant should be considered, they advise.

In this manner, both depression and uncontrolled diabetes and blood pressure may be improved.

SOURCE: Diabetes Care, December 2009.

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