I can't remember the last time that I interviewed six patients in one day. While six may not seem like a very large number of patients to survey in the course of a work day, it's actually quite difficult to find several patients who fit my inclusion criteria, all scheduled on the same day.
As usual, most of the patients I interviewed are Type 2 diabetics: Patients 32, 34, 35, and 37. The two Type 1 diabetics, Patients 33 and 36, had a very healthy (for a diabetic) HbA1c of 6.40% (<7.0% meets the American Diabetes Association's recommended goal for therapy). It follows that their depression survey score could have been so low (PHQ-9 score = 0) partially because their diabetic treatment going so well.
Of the Type 2 diabetics' data, nothing is particularly trend-setting or erratic to be noteworthy. Patient 37, however, seems to be the exception. Nothing in Patient 37's column stood out to me initially — the patient's HbA1c level is not out of control, nor is their PHQ-9 score high enough to consider a diagnosis of a DSM-IV depressive disorder. However, if you look closely at that long list of medications, you'll find bupropion hydrochloride, also known as Wellbutrin®, an antidepressant. Wellbutrin® is prescribed to treat major depressive disorder (MDD), one of the only two DSM-IV depressive disorders that I am considering in this study. According to the severity scoring of the Patient Health Questionnaire-9 (PHQ-9), if the patient has been diagnosed with MDD, they would have to have scored at least a 14 on the survey to be diagnosed with mild MDD. Evidently, this patient's treatment for depression is going well, considering their PHQ-9 score has (presumably) more than halved, but in the very least, has decreased considerably. Additionally, Patient 37's HbA1c level has decreased from 9.0% to 8.3% since their last visit on March 8, when the patient was first prescribed for Wellbutrin®. Keep in mind that glycosolated hemoglobin, or HbA1c, is a three-month average of the amount of sugar in the blood. So a 0.7%-decrease is actually quite considerable of a drop, given that the last HbA1c test was recorded merely one month ago.
So...
Patient 37 is a good example of how depression can impair the proper treatment of diabetes and how treating the depression, in this case, by prescribing the antidepressant Wellbutrin®, actually improves the treatment of the patient's diabetes, as seen by the HbA1c drop. This is consistent with the 'circular' theory between diabetes and depression that I discussed earlier of how the treatment of one condition can improve the treatment of the other when both are present.
Lalani.
As usual, most of the patients I interviewed are Type 2 diabetics: Patients 32, 34, 35, and 37. The two Type 1 diabetics, Patients 33 and 36, had a very healthy (for a diabetic) HbA1c of 6.40% (<7.0% meets the American Diabetes Association's recommended goal for therapy). It follows that their depression survey score could have been so low (PHQ-9 score = 0) partially because their diabetic treatment going so well.
Of the Type 2 diabetics' data, nothing is particularly trend-setting or erratic to be noteworthy. Patient 37, however, seems to be the exception. Nothing in Patient 37's column stood out to me initially — the patient's HbA1c level is not out of control, nor is their PHQ-9 score high enough to consider a diagnosis of a DSM-IV depressive disorder. However, if you look closely at that long list of medications, you'll find bupropion hydrochloride, also known as Wellbutrin®, an antidepressant. Wellbutrin® is prescribed to treat major depressive disorder (MDD), one of the only two DSM-IV depressive disorders that I am considering in this study. According to the severity scoring of the Patient Health Questionnaire-9 (PHQ-9), if the patient has been diagnosed with MDD, they would have to have scored at least a 14 on the survey to be diagnosed with mild MDD. Evidently, this patient's treatment for depression is going well, considering their PHQ-9 score has (presumably) more than halved, but in the very least, has decreased considerably. Additionally, Patient 37's HbA1c level has decreased from 9.0% to 8.3% since their last visit on March 8, when the patient was first prescribed for Wellbutrin®. Keep in mind that glycosolated hemoglobin, or HbA1c, is a three-month average of the amount of sugar in the blood. So a 0.7%-decrease is actually quite considerable of a drop, given that the last HbA1c test was recorded merely one month ago.
So...
Patient 37 is a good example of how depression can impair the proper treatment of diabetes and how treating the depression, in this case, by prescribing the antidepressant Wellbutrin®, actually improves the treatment of the patient's diabetes, as seen by the HbA1c drop. This is consistent with the 'circular' theory between diabetes and depression that I discussed earlier of how the treatment of one condition can improve the treatment of the other when both are present.
Lalani.
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