An 8 Week Educational Program Improves Mental Health Among Poorly Controlled Diabetics

Presentation Number: MON 525
Date of Presentation: April 3rd, 2017

Francisco Eduardo Ramirez*1, Neil Nedley1 and Tim Arakawa2
1Nedley Clinic, Weimar, CA, 2GUAM SEVENTH-DAY ADVENTIST CLINIC, Tamuning



Poor glycemic control can trigger depressive symptoms. Some patients would like a non-pharmacological approach(1). We are reporting on how such an educational program helped this particular group.


A lifestyle education program could improve mood and improve glycemic control.


A medical clinic trained and certified lay and professional people around the world in 4 continents. The focus of the program is educational and it does not create a doctor-patient relationship. Each program is run independently and its purpose is not for profit. Participants are recruited by radio, TV, handouts, newspapers and word of mouth. Those who chose to participate met once a week for 8 weeks for a 2 hour program. It consisted of a 45 minute DVD presentation by an expert in the treatment of depression and a facilitated small group discussion together with weekly practical assignments. Each participant used a workbook to follow through. The program was available in Spanish and English. The Depression and Anxiety Assessment Test [DAAT] (registration TX 7-398-022) was used. It assessed depression level based using a modified PHQ-9 []Patient Health Questionnaire] test, demographics and participant glycemic control. No questions were asked about individuals' treatment of diabetes or depression. The depression was classified according to DSM-5 into 4 categories as none (0-6), mild (7-10), moderate (11-19) or severe (20 or more). The progress was quantified on the category they finished in. The 77 question DAAT questionnaire was administered at baseline and completion. They were taught various healthy lifestyle habits like nutrition, exercise, proper rest, bright light, sleep, and avoiding negative thoughts, among other things.


Of 5997 participants that finished the program, 365 (from USA, Canada, New Zealand, South Africa, Ireland and Australia) answered affirmatively the question: "Are you a diabetic whose blood sugars are not optimally controlled. Average age was 57.4 (SD 12.3), 69% females, 90% Caucasian. Baseline depression score had a mean of 13.9 points (SD 7.5), median 14 and mode 21.

At end of the program depression score had a mean of 8.1 (mild) [SD 6.3], median 8 and mode 0.

At baseline 80% of the poorly controlled diabetic participants had some degree of depression, most of them being moderate to severe degree. Among those with severe depression 98% improved at least one category and another 1% showed some improvement. Only one showed no improvement. No one deteriorated.

At the end of the program 45% reported in the end questionnaire that they had a better glycemic control.


The 8-week depression recovery program was safe and was associated with at least some degree of improvement in the vast majority (88.2%). A control group that does not participate needs to be evaluated. It also needs to see if the improvement will last by doing a long-term follow-up study.


Disclosure: NN: Owner, Nedley Health Solution. Nothing to Disclose: FER, TA