NUR2300 - Cognitive vs Glycemic Therapy for Diabetic Depression

This report investigates the effectiveness of cognitive therapy alongside glycemic therapy for diabetic patients with depression, using a PICO framework to formulate the research question. It evaluates a study on motivational enhancement therapy plus cognitive behavior therapy, highlighting its positive impact on depressive symptoms and quality of life in type-2 diabetes patients. The report emphasizes the intricate relationship between diabetes and depression, advocating for integrated interventions that address both conditions. A literature review supports the benefits of cognitive behavioral therapy and mindfulness-based cognitive therapy in managing depressive symptoms and improving diabetes management. It also explores the potential of web-based and mobile interventions for patients with limited access to mental healthcare. The report recommends training healthcare professionals in cognitive behavioral therapy and developing innovative strategies to reach remote patients, ultimately improving the quality of life for individuals with comorbid diabetes and depression.

Running head: EVIDENCE BASED STUDIES
EVIDENCE BASED STUDIES
Name of the student:
Name of the university:
Author note:

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EVIDENCE BASED STUDIES
Research question:
The research question is prepared with the help of the PICO framework. It mainly contains four
important components that help in forming a proper clinical question. The research question that
is developed is
“Does cognitive therapy along with Glycemic therapy provide better health outcomes on
diabetic patients with depression in comparison to when only Glycemic intervention is
provided alone?”
Different key search terms had been used which include “cognitive behavioral therapy,
Glycemic therapy, better health outcome, diabetes patients, diabetes with depression and others.
These words are mainly fed in the two electronic bases like the PubMed, CINAHL and
Medscape. These phrases were mainly taken in combination with that of the Boolean operators
like the ‘AND’ and ‘OR’. These operators helped in broadening as well as narrowing the search
results. Filters were used as it helped in the extraction of the different arricles that were
published on or after 2014. Only English language paper was selected.
PICO table:
Population Intervention Comparison outcome
Diabetic type 2 patients
with depression
Cognitive behavioral
therapy along with
Glycemic therapy
When only Glycemic
therapy is given to
similar individuals
Better health outcome
on patients with
diabetes and depression

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EVIDENCE BASED STUDIES
Evaluation of the research:
Huang, C. Y., Lai, H. L., Chen, C. I., Lu, Y. C., Li, S. C., Wang, L. W., & Su, Y. (2016).
Effects of motivational enhancement therapy plus cognitive behaviour therapy on
depressive symptoms and health-related quality of life in adults with type II diabetes
mellitus: a randomised controlled trial. Quality of Life Research, 25(5), 1275-1283.
Researchers had conducted an interesting study with the motive of checking the
effectiveness of the motivational enhancement therapy plus cognitive behavior therapy on
depressive symptoms as well as in the health related quality of lives of people with type-2
diabetes. The research paradigm can be considered to be based on positivism (Huang et al.,
2015). This is said so because the researchers had been seen to derive the conclusions about the
effectiveness of the interventions through application of reason as well as logic. About 61
diabetes type-2 patients with depression were selected and were randomly allocated to two
groups. One group was given the usual nutrition based and health education based care. The
other group was also provided the same in addition to motivational enhancement therapy plus
cognitive behavior therapy. The experimental group was seen to experience a significant
reduction in the glycosylated hemoglobin, fasting glucose, and depressive symptoms and a
significant increase in physical quality of life and mental quality of life. The people in the control
group did not show any changes over time. Ethical considerations were followed effectively.
Independent T test was done for statistical analysis if the results of two groups. The Institutional
Review Board had been seen to approve the study. Written consents were taken from the
participants. Confidentiality was also maintained throughout the study.

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EVIDENCE BASED STUDIES
Research topic:
Evidence base articles are of the opinion that diabetes patients become vulnerable to the
development of depression in the course of their health management procedures. About 30 to
40% of the diabetes patients come for treatment in the healthcare centers along with the com-
morbid chronic issues of depression. Therefore, in order to ensure quality life of the patient
provided pharmacological treatment like medication and Glycemic therapy cannot help the
individuals completely to develop quality life. Therefore, nursing professionals need to develop
interventions that would help in treating depression in the diabetes patient besides the mentioned
interventions (Uchendu & Blake, 2017).
Relationships between diabetes and depression are intricately associated. Different
studies have given forward their thesis explaining the connection between depression and
diabetes. Many of the studies have supported that the rigors of management of the diabetes can
be often stressful and this aspect might lead to the symptoms of depression. Other studies have
also found that diabetes can cause different complications and health problems and therefore
these factors might worsen the symptoms of depression (Sharif et al., 2014). Again, the opposite
approaches are discussed in the other articles. Researchers have stated that depression might lead
to different poor lifestyle choices like unhealthy eating, smoking, less exercise and others that are
actually the risk factors of diabetes. Depression can interfere with the ability to take self-care,
perform tasks, and communicate effectively and others and therefore these can interfere with
ability to manage successfully diabetes (Echevaria & Walker, 2014)).

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EVIDENCE BASED STUDIES
Therefore, nurses should try to develop interventions which not only cures diabetes but
also cures depression in the patients as both the disorders are found to be inter-connected and
associated with each other. This research question is prepared following the National Strategic
Framework for chronic conditions. The framework also takes in consideration with the ever-
increasing rates of chronic conditions in the population of Australia because of changes in their
lifestyles (Harvey, 2015). The solving of the research topic will be helping a large population of
people who are suffering from the co-morbid situation of diabetes and depression and leading
poor quality lives.
Literature review:
A study had been conducted a randomized control trial with diabetic patients who were
also suffering from depression. The experimental group who had received motivational
enhancement therapy plus cognitive behavior therapy along with the usual care for diabetes had
better outcomes than the control groups who only received usual care. Positive health outcomes
were found as reduction in the glycosylated hemoglobin, fasting glucose, and depressive
symptoms and increase in physical quality of life and mental quality of life in the experimental
group. However, patients in the control group received the usual care and did not show any
changes over the time (Huang et al., 2015). Therefore, it can be stated that the behavioral
interventions helped in facilitation of the significant improvement in the Glycemic control as
well as psychological adjustment. These helped the patient in strengthening their diabetes control
skills. Therefore, nurses can take part in the delivering of behavioral intervention for diabetes
patients to decrease their depressive symptoms (Sharif et al., 2014)).

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EVIDENCE BASED STUDIES
Another research had also discussed the importance of Mindfulness-Based Cognitive
Therapy and Cognitive Behavior Therapy for the treatment of the depressive symptoms in the
patients with diabetes. One interesting feature was that the researchers only did not consider the
diabetes type-2 patients but also the type-1 patients as well. The study had shown that application
of both MBCT and CBT was associated with greater reduction of the depressive symptoms in the
patient in the experimental group in comparison to the patients in the waiting list control who
received only the usual care (Tovote et al., 2014). Both the interventions were also found to have
a positive impact on the other indicators off functioning as well. It increased the well-being as
well as the reduction of the anxiety and diabetes related distress. Therefore, from this result, it
can be stated that both the psychological interventions not only help in managing depressive
mental issues but also have positive outcomes of diabetes management and ensures better quality
living in the diabetes patient. However, the study showed that these interventions did not have
positive impacts on management of the HbA1c values. These might be because the values were
obtained from patient’s medical records instead of the scheduling additional measurements at
designated time points. Therefore, further researches on this aspect can be conducted in the
future as well.
Another study conducted that showed the efficacy of using web-technology as well as
mobile phone interventions for those diabetic individuals who are also suffering from depression
but have poor access to mental healthcare services or does not want to take mental health
services. The program was named “Mycompass” and had modules with detailed description and
steps that would help in motivating the individuals to change their behaviors and overcome
depressive symptoms. The study showed that consumers have accepted this program positively
and depressive symptoms were seen to be improved significantly. They accepted it as an

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EVIDENCE BASED STUDIES
effective and accept treatment option for the people with the diabetes (Menting et al., 2017).
However, one interesting aspect that the researchers also discussed is the significant and
sustained improvements in the diabetes self-efficacy beliefs and diabetes related distress. The
striking feature found here that although the program “Mycompass” had no diabetes
management specific content, yet it brought out positive outcomes in diabetes related health
situations. Improvement in the self-confidence and being energetic by nature can be the
suspected contributors that make the patients manage their diabetes symptoms and comply with
the interventions successfully.
Dissemination of the research findings can be explained as the process that involves
distribution of the results to the different individuals. Such individuals would be able to use the
information and this would help in maximizing the benefits of the aim without any form of
delay. The primary findings of the research are that cognitive behavioral therapy along with
usual care in diabetic people with depression yield positive outcomes (Semenkovich et al., 2015).
They help in managing the depression and have positive outcomes on the effective management
of diabetes symptoms. The core principle of the dissemination would mainly be focusing on the
engagement off the stakeholders and utilization of the appropriate opportunities. The main
audience would be the nursing professionals involving them from the first steps planning to that
of the steps if implementation (Echevari et al., 2014). Again, gaining feedbacks and suggestions
from the nurses on this approach would help the organizations to develop better plans for
increasing awareness among patients and developing their accessibilities to such forms of
treatments. Podcasts, blogs, and social media, info-graphics and many others can be utilised for
spreading the research ideas among the patients, nurses, healthcare organisations, charities and
others so that they can also get benefits from the research (Alanzi et al., 2014).

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EVIDENCE BASED STUDIES
Recommendation:
It is important for the healthcare professionals working in the primary healthcare centers
to participate in training procedures to develop skills to conduct cognitive behavioral therapy.
Evidence based researches show that most of the patients of diabetes suffer from depression. As
the primary healthcare professionals need to provide holistic and comprehensive care to the
patients, therefore, it becomes their duty to be trained in the psychological therapies besides
providing the usual care to the patients (Nordgreen et al., 2016). The training procedures will
help them to develop skills and will make them able to provide a comprehensive care that will
help in healing both mental and physical symptoms. These would help in developing the quality
life of the patients (Huang et al., 2016).
The healthcare organizations also need to incorporate enough resources so that the
professionals can provide this form of comprehensive treatment plan. Moreover, they should also
brainstorm and find out innovative strategies like the web-based technologies and mobile
applications by which they can make the comprehensive form of treatments reach out to the
remote areas of the nation or for those who are suffering from self-stigma and do not want to
reveal the mental health issues to professionals (Hermans et al., 2015). Development of patient
awareness is also important and patients should be made to know about the treatments options
that include such psychological therapies. Organizations should develop policies and incorporate
the interventions in diabetes treatment and management protocols (Menting et al., 2017).

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EVIDENCE BASED STUDIES
References:
Alanzi, T. M., Istepanian, R. S., & Philip, N. (2014, August). An integrated model for cognitive
behavioural therapy for mobile diabetes self-management system. In 2014 36th Annual
International Conference of the IEEE Engineering in Medicine and Biology Society (pp.
5393-5396). IEEE.
Echevarria, I. M., & Walker, S. (2014). To make your case, start with a PICOT
question. Nursing2018, 44(2), 18-19.
Harvey, J. N. (2015). Psychosocial interventions for the diabetic patient. Diabetes, metabolic
syndrome and obesity: targets and therapy, 8, 29.
Hermanns, N., Schmitt, A., Gahr, A., Herder, C., Nowotny, B., Roden, M., ... & Kulzer, B.
(2015). The effect of a diabetes-specific cognitive behavioral treatment program
(DIAMOS) for patients with diabetes and subclinical depression: results of a randomized
controlled trial. Diabetes Care, dc141416.
Huang, C. Y., Lai, H. L., Chen, C. I., Lu, Y. C., Li, S. C., Wang, L. W., & Su, Y. (2016). Effects
of motivational enhancement therapy plus cognitive behaviour therapy on depressive
symptoms and health-related quality of life in adults with type II diabetes mellitus: a
randomised controlled trial. Quality of Life Research, 25(5), 1275-1283.
Menting, J., Tack, C. J., van Bon, A. C., Jansen, H. J., van den Bergh, J. P., Mol, M. J., ... &
Knoop, H. (2017). Web-based cognitive behavioural therapy blended with face-to-face

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EVIDENCE BASED STUDIES
sessions for chronic fatigue in type 1 diabetes: a multicentre randomised controlled
trial. The Lancet Diabetes & Endocrinology, 5(6), 448-456.
Nordgreen, T., Haug, T., Öst, L. G., Andersson, G., Carlbring, P., Kvale, G., ... & Havik, O. E.
(2016). Stepped care versus direct face-to-face cognitive behavior therapy for social
anxiety disorder and panic disorder: A randomized effectiveness trial. Behavior
therapy, 47(2), 166-183.
Semenkovich, K., Brown, M. E., Svrakic, D. M., & Lustman, P. J. (2015). Depression in type 2
diabetes mellitus: prevalence, impact, and treatment. Drugs, 75(6), 577-587.
Sharif, F., Masoudi, M., Ghanizadeh, A., Dabbaghmanesh, M. H., Ghaem, H., & Masoumi, S.
(2014). The effect of cognitive-behavioral group therapy on depressive symptoms in
people with type 2 diabetes: A randomized controlled clinical trial. Iranian Journal of
nursing and midwifery research, 19(5), 529.
Tovote, K. A., Fleer, J., Snippe, E., Peeters, A. C., Emmelkamp, P. M., Sanderman, R., ... &
Schroevers, M. J. (2014). Individual mindfulness-based cognitive therapy (MBCT) and
cognitive behavior therapy (CBT) for treating depressive symptoms in patients with
diabetes: results of a randomized controlled trial. Diabetes care, DC_132918.
Tovote, K. A., Schroevers, M. J., Snippe, E., Sanderman, R., Links, T. P., Emmelkamp, P. M., &
Fleer, J. (2015). Long-term effects of individual mindfulness-based cognitive therapy and
cognitive behavior therapy for depressive symptoms in patients with diabetes: a
randomized trial. Psychotherapy and psychosomatics, 84(3), 186-187.

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EVIDENCE BASED STUDIES
Uchendu, C., & Blake, H. (2017). Effectiveness of cognitive–behavioural therapy on glycaemic
control and psychological outcomes in adults with diabetes mellitus: a systematic review
and meta‐analysis of randomized controlled trials. Diabetic Medicine, 34(3), 328-339.
Appendix:
Huang, C. Y., Lai, H. L., Chen, C. I., Lu, Y. C., Li, S. C., Wang, L. W., & Su, Y. (2016).
Effects of motivational enhancement therapy plus cognitive behaviour therapy on
depressive symptoms and health-related quality of life in adults with type II diabetes
mellitus: a randomised controlled trial. Quality of Life Research, 25(5), 1275-1283. DOI
10.1007/s11136-015-1165-6
This article showed that motivational enhancement therapy plus cognitive behavior
therapy helped in bringing positive outcomes on not only depression symptoms but also
helped in managing diabetes as well. The experimental group was seen to experience a
significant reduction in the glycosylated hemoglobin, fasting glucose, and depressive
symptoms and a significant increase in physical quality of life and mental quality of life.
The people in the control group did not show any changes over time.
Tovote, K. A., Fleer, J., Snippe, E., Peeters, A. C., Emmelkamp, P. M., Sanderman, R., ... &
Schroevers, M. J. (2014). Individual mindfulness-based cognitive therapy (MBCT) and
cognitive behavior therapy (CBT) for treating depressive symptoms in patients with
diabetes: results of a randomized controlled trial. Diabetes care, DC_132918. DOI:
10.2337/dc13-2918
Individual mindfulness-based cognitive therapy (MBCT) and cognitive behavior therapy
(CBT) help in treating depression symptoms in patients with diabetes. However, they also

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EVIDENCE BASED STUDIES
bring fruitful results in increased well-being as well as the reduction of the anxiety and
diabetes related distress. However, they did not show positive outcomes of management
of the HbA1c levels.
Menting, J., Tack, C. J., van Bon, A. C., Jansen, H. J., van den Bergh, J. P., Mol, M. J., ...
& Knoop, H. (2017). Web-based cognitive behavioral therapy blended with face-to-face
sessions for chronic fatigue in type 1 diabetes: a multicentre randomized controlled
trial. The Lancet Diabetes & Endocrinology, 5(6), 448-456.
Web based technology and mobile applications helps in providing overall development of
mental health conditions of patients align with self-efficacy in handling diabetes
interventions and guidelines.

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EVIDENCE BASED STUDIES
References: