PMID- 31221693
OWN - NLM
STAT- MEDLINE
DCOM- 20200323
LR  - 20200701
IS  - 1935-5548 (Electronic)
IS  - 0149-5992 (Print)
IS  - 0149-5992 (Linking)
VI  - 42
IP  - 7
DP  - 2019 Jul
TI  - Program ACTIVE II: Outcomes From a Randomized, Multistate Community-Based 
      Depression Treatment for Rural and Urban Adults With Type 2 Diabetes.
PG  - 1185-1193
LID - 10.2337/dc18-2400 [doi]
AB  - OBJECTIVE: Depression (major depressive disorder [MDD]) in adults with type 2 
      diabetes mellitus (T2DM) is associated with worsened diabetes complications, 
      increased health care costs, and early mortality. Program ACTIVE II was a 
      randomized, controlled, multicenter treatment trial designed to test the 
      comparative effectiveness of cognitive behavioral therapy (CBT) and/or 
      community-based exercise (EXER) on diabetes and depression outcomes compared with 
      usual care (UC). RESEARCH DESIGN AND METHODS: Using a 2 x 2 factorial randomized 
      controlled trial design, adults with T2DM for >/=1 year who met DSM-IV-TR criteria 
      for MDD were randomized to CBT (10 sessions occurring over 12 weeks; N = 36), 
      EXER (12 weeks of community-based exercise including six sessions with a personal 
      trainer; N = 34), CBT+EXER (concurrent over a 12-week period; N = 34), and UC (N 
      = 36). Primary outcomes were depression remission rate (assessed by psychiatric 
      interviewers blind to assignment) and change in glycemic control (HbA(1c)). 
      RESULTS: The mean age was 56.0 years (SD 10.7). Participants were female (77%), 
      white (71%), and married (52%). After controlling for education and 
      antidepressant use, odds of achieving full MDD remission in the intervention 
      groups were 5.0-6.8 times greater than UC (P < 0.0167). The CBT+EXER group 
      demonstrated improved HbA(1c) compared with UC. For participants with a baseline 
      HbA(1c) >/=7.0%, exploratory post hoc subgroup analysis showed that the CBT+EXER 
      group had a 1.1% improvement in HbA(1c) (P < 0.0001) after controlling for 
      covariates. CONCLUSIONS: The Program ACTIVE behavioral treatment interventions 
      demonstrated clinically meaningful improvements in depression outcomes in adults 
      with T2DM and MDD. These community-based interventions are complementary to 
      medical care and extend access to those in rural and urban areas.
CI  - (c) 2019 by the American Diabetes Association.
FAU - de Groot, Mary
AU  - de Groot M
AUID- ORCID: 0000-0003-4021-8824
AD  - Indiana University School of Medicine, Indianapolis, IN mdegroot@iu.edu.
FAU - Shubrook, Jay H
AU  - Shubrook JH
AD  - Touro University California College of Osteopathic Medicine, Vallejo, CA.
AD  - Ohio University Heritage College of Osteopathic Medicine, Athens, OH.
FAU - Hornsby, W Guyton Jr
AU  - Hornsby WG Jr
AD  - West Virginia University School of Medicine, Morgantown, WV.
FAU - Pillay, Yegan
AU  - Pillay Y
AD  - Ohio University, Athens, OH.
FAU - Mather, Kieren J
AU  - Mather KJ
AUID- ORCID: 0000-0001-8696-7500
AD  - Indiana University School of Medicine, Indianapolis, IN.
FAU - Fitzpatrick, Karen
AU  - Fitzpatrick K
AD  - West Virginia University School of Medicine, Morgantown, WV.
FAU - Yang, Ziyi
AU  - Yang Z
AD  - Indiana University School of Medicine, Indianapolis, IN.
FAU - Saha, Chandan
AU  - Saha C
AD  - Indiana University School of Medicine, Indianapolis, IN.
LA  - eng
SI  - ClinicalTrials.gov/NCT03371940
GR  - R18 DK092765/DK/NIDDK NIH HHS/United States
GR  - R34 DK071545/DK/NIDDK NIH HHS/United States
PT  - Journal Article
PT  - Multicenter Study
PT  - Randomized Controlled Trial
PT  - Research Support, N.I.H., Extramural
DEP - 20190521
PL  - United States
TA  - Diabetes Care
JT  - Diabetes care
JID - 7805975
RN  - 0 (Antidepressive Agents)
RN  - 0 (Blood Glucose)
SB  - IM
MH  - Adult
MH  - Aged
MH  - Antidepressive Agents/therapeutic use
MH  - Blood Glucose/metabolism
MH  - Cognitive Behavioral Therapy/methods
MH  - Combined Modality Therapy
MH  - Community Health Services/methods
MH  - Depression/complications/epidemiology/*therapy
MH  - Depressive Disorder, Major/complications/epidemiology/therapy
MH  - Diabetes Mellitus, Type 2/complications/psychology/*therapy
MH  - Exercise Therapy/methods
MH  - Female
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Rural Population/statistics & numerical data
MH  - Treatment Outcome
MH  - United States/epidemiology
MH  - Urban Population/statistics & numerical data
PMC - PMC6609961
EDAT- 2019/06/22 06:00
MHDA- 2020/03/24 06:00
PMCR- 2020/07/01
CRDT- 2019/06/22 06:00
PHST- 2018/11/20 00:00 [received]
PHST- 2019/04/18 00:00 [accepted]
PHST- 2019/06/22 06:00 [entrez]
PHST- 2019/06/22 06:00 [pubmed]
PHST- 2020/03/24 06:00 [medline]
PHST- 2020/07/01 00:00 [pmc-release]
AID - dc18-2400 [pii]
AID - 2400 [pii]
AID - 10.2337/dc18-2400 [doi]
PST - ppublish
SO  - Diabetes Care. 2019 Jul;42(7):1185-1193. doi: 10.2337/dc18-2400. Epub 2019 May 
      21.