Semester

Summer

Date of Graduation

2004

Document Type

Dissertation

Degree Type

PhD

College

School of Pharmacy

Department

Pharmaceutical Sciences

Committee Chair

Suresh Madhavan.

Abstract

Presence of depression in patients with type 2 diabetes may affect their adherence to oral hypoglycemics and consequently glycemic control and economic outcomes. These potential effects may be more significant when one considers that depression is highly prevalent in patients with diabetes. This study involved two phases. Phase one of the study examined the epidemiological relationship between depression and type 2 diabetes. Phase two of the study examined the impact of depression on patterns of use and adherence to oral hypoglycemics in newly diagnosed type 2 diabetes patients. Impact of depression on expenditures related to type 2 diabetes and overall health care was also estimated. The study also tested the mediating influence of adherence between depression and type 2 diabetes expenditures. Results of phase one of the study indicated that depression was more prevalent in patients with type 2 diabetes as compared to a control group. Results also indicated that females with depression were more likely to develop type 2 diabetes as compared to those without depression. Phase two results indicated that patients without depression had a more favorable pattern of oral hypoglycemic use with a significantly lower proportion of non-depressed patients switching, augmenting, or discontinuing their oral hypoglycemics as compared to depressed patients. Depressed patients were also found to have significantly lower adherence to oral hypoglycemics as compared to non-depressed patients. Multivariate analyses indicated that patients with depression incurred 21.30% higher type 2 diabetes related costs as compared to non-depressed patients. This difference was primarily due to a higher probability of an ER/hospitalization episode in depressed patients. Similarly, patients with depression had 32.10% higher overall health care costs as compared to patients without depression. Depression was associated with increased costs in all areas of health care such as ER/hospitalization, outpatient, and prescription costs. Mediation analysis indicated that adherence to oral hypoglycemics was not a mediator between depression and type 2 diabetes related expenditures. Thus, depression could have potentially impacted type 2 diabetes related outcomes directly through a physiological effect on glycemic levels or indirectly through its impact on adherence to other behaviors such as diet or exercise.

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