Randomized Trial of a Tailored Cognitive Behavioral Intervention in Type 2 Diabetes with Comorbid Depressive and/or Distress Symptoms—Twelve-Month Outcomes from COMRADE
Bibliographic record
Abstract
Patients with type 2 diabetes (T2D) and co-morbid depressive and/or distress symptoms have poor glycemic control and worse health outcomes. This prospective randomized controlled trial evaluated the effectiveness of a 16-session severity tailored cognitive behavioral intervention plus lifestyle change counseling (n = 67; IG=intervention group) delivered by trained staff compared to usual care (n = 72; CG=control group), in 139 rural adult patients (mean age = 52.6 ± 9.5 years.; 72% black; BMI = 37.0 ± 9.0) with uncontrolled (mean HbA1c = 9.6 ± 2.0) T2D (52% on insulin) and co-morbid depressive (PHQ-2) or distress (DDS-2) symptoms at screening in an academic primary care clinic. At baseline and at 12-month follow-up: height, weight, BP, A1c, diabetes distress (DDS-17), depressive symptoms (PHQ-9), self-care behaviors (SDSCA), empowerment (DES), and medication adherence (ModMAS) were measured using validated instruments. There were no differences between groups at baseline. Between group (IG vs. CG) differences at 12-months follow-up were significant for changes from baseline in diabetes-related distress (-0.83 ± 0.88 vs. -0.15 ± 0.92; p = 0.001), regimen-related distress (-1.12 ± 1.vs. -0.31 ± 1.22; p = 0.001), depressive symptoms (-3.39 ± 5.00 vs. -0.90 ± 6.17; p = 0.01), self-care behaviors (+1.10 ± 1.30 vs. +0.58 ± 1.45; p = 0.03), and medication adherence (+1.00 ± 2.0 vs. +0.17 ± 1.0; p = 0.02). Differences in change in A1c (-0.92 ± 1.81 vs. -0.31 ± 2.04; p = 0.06) were substantially greater in the intervention group and achieved borderline significance. There were no significant differences in glycemic response patterns by race or gender. A tailored cognitive behavioral intervention significantly improves behavioral outcomes and glycemic control in rural black and white patients with T2D and co-morbid depressive and/or distress symptoms. Disclosure D.M. Cummings: None. L. Lutes: None. S. Patil: None. B. Hambidge: None. M. Carraway: None. K. Littlewood: None. A. Adams: None. C. Solar: None. S. Edwards: None. P. Gatlin: None.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.003 | 0.002 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.007 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".