Re: I'm pretty fucking depressed


Hang in here Jacki. Depression is a major side effect of heart
disease and it looks like diabetes may also have this problem. Perhaps
all major chronic problems do.

Bill


"General health status was lower, body mass index higher, and insulin
treatment more frequent; history of prior coronary heart disease was
less frequent. They were more likely to indicate depression and
hopelessness and to identify costs as a barrier to self-care; less
likely to report trust in their regular physician; and more likely to
smoke cigarettes and be physically inactive."

From below.

.....................................

Understanding the Gap Between Good Processes of Diabetes Care and Poor
Intermediate Outcomes: Translating Research Into Action for Diabetes
(TRIAD).
Selby JV, Swain BE, Gerzoff RB, Karter AJ, Waitzfelder BE, Brown AF,
Ackermann RT, Duru OK, Ferrara A, Herman W, Marrero DG, Caputo D,
Narayan KM; for the TRIAD Study Group.
From the *Division of Research, Kaiser Permanente Medical Care Program,
Northern California, Oakland, California; ÝDivision of Diabetes
Translation, Centers for Disease Control and Prevention (CDC), Atlanta,
Georgia; ýPacific Health Research Institute, Honolulu, Hawaii;
§Department of Medicine, David Geffen School of Medicine, University of
California, Los Angeles, Los Angeles, California; ¶Department of
Medicine, Indiana University School of Medicine, Indianapolis, Indiana;
?School of Medicine, University of Michigan, Ann Arbor, Michigan;
**University of Medicine and Dentistry of New Jersey, Center for
Continuing and Outreach Education, Newark, New Jersey; ÝÝRollins School
of Public Health, Emory University, Atlanta, Georgia; ýýfor a list of
the TRIAD Study Group, see .
BACKGROUND:: Performance of diabetes clinical care processes has
improved recently, but control of hemoglobin A1c (A1c) and other
vascular disease risk factors has improved more slowly. OBJECTIVES:: To
identify patient factors associated with control of vascular disease
risk factors among diabetes patients receiving recommended care
processes. POPULATION:: Managed care enrollees who participated in the
TRIAD (Translating Research into Action for Diabetes) Study and received
at least 5 of 7 recommended care processes during the 12 months before
the second survey (2002-2003). METHODS:: Comparison of 1003 patients
with good control of A1c (<8%), systolic blood pressure (<140 mm Hg) and
LDL-cholesterol (<130 mg/dL) versus 812 patients with poor control for
at least 2 of these factors. RESULTS:: Poorly controlled patients were
younger, more frequently female, African American, with lower education
and income (P < 0.001 for each). General health status was lower, body
mass index higher, and insulin treatment more frequent; history of prior
coronary heart disease was less frequent. They were more likely to
indicate depression and hopelessness and to identify costs as a barrier
to self-care; less likely to report trust in their regular physician;
and more likely to smoke cigarettes and be physically inactive.
Adjusting for demographic and clinical variables, concerns about costs,
low trust in one's physician, current smoking, and physical inactivity
remained associated with poor control. However, inclusion of these 4
variables in a single model did not diminish associations of
race/ethnicity or education with control. CONCLUSIONS:: Clinical,
socioeconomic, psychosocial, and behavioral factors were independently
associated with poor control. However, these factors did not fully
explain observed racial and socioeconomic disparities in control.
PMID: 18007164 [PubMed - as supplied by publisher]

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