Defense Date

8-10-2018

Graduation Date

Fall 12-21-2018

Availability

One-year Embargo

Submission Type

thesis

Degree Name

MS

Department

Pharmacy Administration

School

School of Pharmacy

Committee Chair

Jordan Covvey

Committee Member

Khalid Kamal

Committee Member

Vincent Giannetti

Keywords

anxiety, depression, diabetic outcomes, type 2 diabetes

Abstract

Objective: To evaluate the impact of depression and/or anxiety on clinical outcomes of diabetes, including glycosylated hemoglobin (HgA1c), blood glucose, blood pressure, total cholesterol, weight and LDL among patients with incident type 2 diabetes mellitus (T2DM).

Method: A retrospective cohort study utilizing electronic medical record (EMR) data from a primary care physician (PCP) group practice was conducted to identify patients newly diagnosed with T2DM with at least 6 months pre-diagnosis and 12 months post-diagnosis of EMR data using International Classification of Disease 9th edition Clinical Modification (ICD-9-CM) coding. The presence of comorbid depression and anxiety was identified to identify four cohorts: (1) patients with T2DM only, (2) patients with T2DM and depression, (3) patients with T2DM and anxiety, and (4) patients with T2DM and depression and anxiety. Data regarding patients’ demographic, clinical characteristics, lab results and medication utilization during the first year following diagnosis of T2DM (the index date) were gathered. Analyses included comparison of patients’ demographics and clinical characteristics (using matching), evaluation of clinical outcomes of diabetes with regard to mental illness diagnosis, and examination of mental illness treatment and mental illness severity. Finally, factors predicting HgA1c goal attainment were assessed via the use of a logistic regression model.

Result: The inclusion/exclusion criteria led to a study sample of 1822 T2DM patients amongst whom 1410 had T2DM only, 148 had T2DM and concomitant depression, 215 had T2DM and concomitant anxiety, 49 had T2DM and both depression and anxiety. Significant reductions in HgA1c occurred across all four groups from baseline to follow-up (p

Conclusion: The findings suggest that comorbid depression and/or anxiety have limited singular influence upon clinical outcomes of diabetes among patients with T2DM. Further work should examine additional clinical outcomes for diabetes and model the influence of demographic and clinical contributors to these outcomes. Limitations of the study include generalizability, degree of missing data, lack of information on other potentially influential predictors, misclassification bias and reliability of coding utilized to isolate study sample.

Format

PDF

Language

English

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