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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):459-66DC

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.

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.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

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 -