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Treat depression to control blood sugar.

The Diabetes Control and Complications Trial, the landmark study completed in 1994, concluded unequivocally that keeping a close rein on blood sugar can prevent or delay the kidney, eye, and nerve complications that affect patients with diabetes. For some, though, that goal is nearly impossible. Diabetics with depression have a very difficult time managing their blood sugar levels.

Investigators at Washington University School of Medicine in St. Louis have found that treating clinical depression with the anti-depressant drug nortriptyline helps patients control their blood sugar, even though it tends to raise blood glucose levels. In depressed diabetics, treating depression more than made up for those increases in blood sugar.

"The drug had two opposing effects," explains Patrick J. Lustman, associate professor of psychiatry. "It improved depression significantly, but it worsened glucose control in patients who were not depressed. Yet, even in the face of this opposing effect, we found that as depression improved, glucose control did, too."

Depression has a negative influence on quality of life for anyone, but can cause additional problems for patients with diabetes because it is associated closely with poor glucose control as well as lower compliance with diabetes treatment. While depression affects about five percent of the general population at a given time, the rate is between 15 and 20% in those with diabetes.

"There are several theories about why depression has such a negative effect on patients with diabetes," Lustman points out. "Depressed patients may not comply with their treatment regimens, or perhaps depression may cause changes in neuroendocrine function, making blood sugar especially difficult to control."

In patients who were depressed and given nortriptyline, blood glucose levels improved along with psychiatric health. "Each one-point drop in the index that we use to measure depression correlated with a small reduction in blood sugar levels."
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Title Annotation:Washington Univ School of Medicine researchers discover that treating depression in diabetics helps to control their blood sugar levels
Publication:USA Today (Magazine)
Article Type:Brief Article
Date:Oct 1, 1997
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