Tuesday, April 10, 2012

Patient Surveys: Day 15

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 HbA1cis 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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