Abstract 128: Screening for depression and its association with Self-care, medication adherence and preventive control among patients with diabetes mellitus - A cross-sectional study at a Tertiary Care Teaching Hospital in Kerala

Background: Undiagnosed depression is common and is known to affect various aspects of medical care. Objective: To comparea) medication adherence, b) glycaemic control, c) adherence to lifestyle modifications and, d) self-careamong diabetic patients with depression as against those without. Methods: A cross-sectional study was done among outpatients in 2019, who met the inclusion criteria and consented. Malayalam version of PHQ 9, a validated scale was used for screening for depression. All patients who were diagnosed or treated for any psychiatric illness, on psychotropic or with recent stressor were excluded. Enrolled were assessed regarding diabetes self-care practices, medication adherence, glycaemic control, and lifestyle modifications. Baseline blood work including HbA1c was performed. Self-monitoring of blood glucose charts was assessed. A comparison was done based on the acquired data between depressed and non-depressed. All the statistical analysis were performed using SAS ODA software. Suitable statistical tests like chi-square test, and Odds ratio were performed. A p-value < 0.05 was considered to be statistically significant. Results: Total of 140 patients with 67 (47.8%) females were evaluated. Mean age was 46.5 ± 10.8 years. Mean duration of diabetes was 11.8 ± 8 8.8 years. Mean HbA1c was 9.0 ± 1.92%. There were 79 (56.42%) patients who had depression and among them 37 (26.42%) had moderate to severe depression. Women were 3 times more at risk of depression than men. Those with low adherence to medications had 3.9 times higher chance of being depressed. Depression was not associated with the self-care score but was associated with many aspects of self-care such as regular exercise, eating on time and adherence to medication. Lack of adherence was due to forgetfulness not a wilful decision to not comply. Conclusion: There was unexpectedly high levels of moderate to severe undiagnosed depression among our diabetic patients. It is important to implement effective screening programs for all diabetic patients and to initiate early intervention programs for high-risk patients. This will help to prevent future complications arising from poor self-care activities and non-compliance to medication as seen in those diabetic patients with undiagnosed depression.