Problems That Extend Visit Time and Cost in Diabetes Care: 1. How Depression May Affect the Efficacy and Cost of Care of Diabetic Patients

In theory, depression should stand outas a condition that would negativelyaffect the success of therapy in dia-betic patients or patients with impaired glucose tolerance. Depression is known to negatively alter eating patterns, sleep patterns, and activity levels. All of these influences could adversely affect the success of lifestyle modification in dia-betic patients. In addition, depression may reduce the ability of patients to carry out complex tasks, such as those required for diabetes self-care. Given these links, it is surprising that the available literature on interactions between the two conditions is so sparse. Recently, a major review of the possible interactions was published for psychia-trists.1 This emphasized how many influ-ences insulin resistance and diabetes might exert on depression. Therefore, it also seems important to examine the possible effects depression may have on diabetes