Psychiatric referral and glycemic control of Egyptian type 2 diabetes mellitus patients with depression

• Published in: General hospital psychiatry 2016-05, Vol.40, p.60-67
• Main Authors: Fawzi, Mounir H., F.R.C., Psych, Said, Nagwa S., M.D, Fawzi, Maggie M., M.D, Kira, Ibrahim A., Ph.D, Fawzi, Mohab M., M.D, Abdel-Moety, Hanaa, M.D
• Format: Article
• Language: English
• Subjects: Adult; Antidepressive Agents, Second-Generation - administration & dosage; Antidepressive Agents, Second-Generation - pharmacology; Blood Glucose - analysis; Depression; Depressive Disorder, Major - diagnosis; Depressive Disorder, Major - drug therapy; Depressive Disorder, Major - psychology; Diabetes; Diabetes Mellitus, Type 2 - blood; Diabetes Mellitus, Type 2 - drug therapy; Diabetes Mellitus, Type 2 - psychology; Egypt; Female; Fluoxetine - administration & dosage; Fluoxetine - pharmacology; Humans; Hypoglycemic Agents - administration & dosage; Male; Medication Adherence - statistics & numerical data; Middle Aged; Outcome Assessment (Health Care) - statistics & numerical data; Patient Acceptance of Health Care - statistics & numerical data; Prospective Studies; Psychiatry; Referral; Referral and Consultation - statistics & numerical data; Social Stigma; Stigma
• ISSN: 0163-8343; 1873-7714
• DOI: 10.1016/j.genhosppsych.2016.01.002

Abstract Objective To evaluate the relationship between psychiatric referral acceptance for fluoxetine treatment and glycemic control in type 2 diabetes mellitus (T2DM) Egyptian patients with depression. Methods Patients with T2DM who attended the diabetes outpatients clinic at Zagazig University Hospital, Egypt, between May 2013 and April 2015 and who scored ≥ 20 on screening with the Major Depression Inventory (MDI) ( n = 196) were offered a psychiatric referral for fluoxetine treatment and monitoring. Decliners (56.1%) received time/attention matched care via diabetologist visits (attentional controls). Fluoxetine patients and controls were compared at the time of the offer (T1) and 8 weeks later (T2). Factors that significantly correlated with glycemic control were used in a linear regression analysis as the independent variables. Results Eighty-six patients (43.9%) accepted psychiatric referral. Most of them (97.7%) remained throughout the study adherent to fluoxetine (mean daily dose = 31.9 mg). At T2, these patients, in comparison to controls, showed a reduction from baseline in MDI, fasting plasma glucose and glycosylated hemoglobin (HbA1c) levels ( P for all comparisons < .001). In the final model of a regression analysis, 65.9% of the variation in percentage change in HbA1c was explained by adherence to antidiabetics, psychiatric referral acceptance and Internalized Stigma of Mental Illness (ISMI) and MDI scores. Conclusion In T2DM patients with depression, psychiatric referral acceptance for fluoxetine treatment is a significant predictor of both depression and glycemic control improvements.