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Factors influencing glycemic control in type 2 diabetes during acute- and maintenance-phase treatment of major depressive disorder with bupropion.

Abstract

OBJECTIVE

Depression management in both short- and longer-term treatment studies has been associated with improvement in glycemic control. We used bupropion hydrochloride (Wellbutrin XL) to determine whether this improvement could be attributed to changes in anthropometrics or diabetes self-care.

RESEARCH DESIGN AND METHODS

Ninety-three patients with type 2 diabetes and major depressive disorder (MDD) received bupropion hydrochloride in a two-phase, open-label treatment trial. Those who completed the acute phase (10 weeks; n = 75) and whose depression remitted (n = 63) continued bupropion at the remission dose and were followed in the maintenance phase (24 weeks) until attrition (n = 8) or relapse of MDD (n = 0). Self-report scales were used to measure depression symptom severity and diabetes self-care behaviors. Body composition and glycemic control were determined using dual-energy X-ray absorptiometry and serial determinations of A1C.

RESULTS

BMI, total fat mass, and A1C decreased and composite diabetes self-care improved over the acute phase (-0.5 kg/m2, -0.7 kg, -0.5%, and +0.4, respectively, P < 0.01 for each), effects that persisted through the maintenance phase for BMI, A1C, and self-care (P < or = 0.01 for each). Reductions in BMI (B = 0.30, P = 0.01) and depression severity (B = 0.04, P = 0.046) independently predicted lower A1C after acute-phase treatment, whereas only reduction in depression severity (B = 0.08, P = 0.001) predicted A1C over the maintenance interval.

CONCLUSIONS

In the short term, improvement in glycemic control during bupropion treatment is predicted independently by improvements in mood and body composition. Longer-term improvements in glycemic control are predicted primarily by sustained improvement in mood via mechanisms independent of anthropometric and self-care modifications.

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  • Authors+Show Affiliations

    ,

    Department of Psychiatry, Washington University School of Medicine, 660 S. Euclid Ave., Campus Box 8134, St. Louis, MO 63110, USA. lustmanp@wustl.edu

    , , ,

    Source

    Diabetes care 30:3 2007 Mar pg 459-66

    MeSH

    Absorptiometry, Photon
    Adult
    Age of Onset
    Antidepressive Agents, Second-Generation
    Blood Glucose
    Body Composition
    Bupropion
    Depressive Disorder
    Diabetes Mellitus, Type 2
    Educational Status
    Female
    Glycated Hemoglobin A
    Humans
    Male
    Middle Aged

    Pub Type(s)

    Journal Article
    Research Support, N.I.H., Extramural
    Research Support, Non-U.S. Gov't

    Language

    eng

    PubMed ID

    17327305

    Citation

    Lustman, Patrick J., et al. "Factors Influencing Glycemic Control in Type 2 Diabetes During Acute- and Maintenance-phase Treatment of Major Depressive Disorder With Bupropion." Diabetes Care, vol. 30, no. 3, 2007, pp. 459-66.
    Lustman PJ, Williams MM, Sayuk GS, et al. Factors influencing glycemic control in type 2 diabetes during acute- and maintenance-phase treatment of major depressive disorder with bupropion. Diabetes Care. 2007;30(3):459-66.
    Lustman, P. J., Williams, M. M., Sayuk, G. S., Nix, B. D., & Clouse, R. E. (2007). Factors influencing glycemic control in type 2 diabetes during acute- and maintenance-phase treatment of major depressive disorder with bupropion. Diabetes Care, 30(3), pp. 459-66.
    Lustman PJ, et al. Factors Influencing Glycemic Control in Type 2 Diabetes During Acute- and Maintenance-phase Treatment of Major Depressive Disorder With Bupropion. Diabetes Care. 2007;30(3):459-66. PubMed PMID: 17327305.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Factors influencing glycemic control in type 2 diabetes during acute- and maintenance-phase treatment of major depressive disorder with bupropion. AU - Lustman,Patrick J, AU - Williams,Monique M, AU - Sayuk,Gregory S, AU - Nix,Billy D, AU - Clouse,Ray E, PY - 2007/3/1/pubmed PY - 2007/4/28/medline PY - 2007/3/1/entrez SP - 459 EP - 66 JF - Diabetes care JO - Diabetes Care VL - 30 IS - 3 N2 - OBJECTIVE: Depression management in both short- and longer-term treatment studies has been associated with improvement in glycemic control. We used bupropion hydrochloride (Wellbutrin XL) to determine whether this improvement could be attributed to changes in anthropometrics or diabetes self-care. RESEARCH DESIGN AND METHODS: Ninety-three patients with type 2 diabetes and major depressive disorder (MDD) received bupropion hydrochloride in a two-phase, open-label treatment trial. Those who completed the acute phase (10 weeks; n = 75) and whose depression remitted (n = 63) continued bupropion at the remission dose and were followed in the maintenance phase (24 weeks) until attrition (n = 8) or relapse of MDD (n = 0). Self-report scales were used to measure depression symptom severity and diabetes self-care behaviors. Body composition and glycemic control were determined using dual-energy X-ray absorptiometry and serial determinations of A1C. RESULTS: BMI, total fat mass, and A1C decreased and composite diabetes self-care improved over the acute phase (-0.5 kg/m2, -0.7 kg, -0.5%, and +0.4, respectively, P < 0.01 for each), effects that persisted through the maintenance phase for BMI, A1C, and self-care (P < or = 0.01 for each). Reductions in BMI (B = 0.30, P = 0.01) and depression severity (B = 0.04, P = 0.046) independently predicted lower A1C after acute-phase treatment, whereas only reduction in depression severity (B = 0.08, P = 0.001) predicted A1C over the maintenance interval. CONCLUSIONS: In the short term, improvement in glycemic control during bupropion treatment is predicted independently by improvements in mood and body composition. Longer-term improvements in glycemic control are predicted primarily by sustained improvement in mood via mechanisms independent of anthropometric and self-care modifications. SN - 1935-5548 UR - https://www.unboundmedicine.com/medline/citation/17327305/Factors_influencing_glycemic_control_in_type_2_diabetes_during_acute__and_maintenance_phase_treatment_of_major_depressive_disorder_with_bupropion_ L2 - http://care.diabetesjournals.org/cgi/pmidlookup?view=long&amp;pmid=17327305 DB - PRIME DP - Unbound Medicine ER -