Abstract
Diabetes mellitus is a chronic health condition distinguished by a complex set of self-management behaviors needed to achieve blood glucose control in order to minimize risk of future complications. Diabetes is a highly prevalent disease with as many as 14 % of US adults are estimated to have diagnosed or undiagnosed diabetes. Those with diagnosed diabetes are at increased risk for certain psychological conditions, including depression, anxiety, and diabetes-related emotional distress. Importantly, subclinical symptoms of emotional distress have been linked to poorer self-management and poorer health outcomes among individuals treated for diabetes. An integrative approach that follows behavioral medicine principles is needed to improve emotional well-being and self-management outcomes. Research on cognitive behavioral therapy for adherence and depression (CBT-AD) has demonstrated benefits for improved glycemic control, diabetes self-management, adherence, and depression. The current chapter provides an overview of the diagnostic presentation of patients with diabetes, describes the CBT-AD approach developed within the Behavioral Medicine Service at Massachusetts General Hospital, and illustrates its application with a case example.
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References
Menke A, Casagrande S, Geiss L, Cowie CC. Prevalence of and trends in diabetes among adults in the United States, 1988–2012. JAMA. 2015;314:1021–9. doi:10.1001/jama.2015.10029.
Glasgow RE, Boles SM, McKay HG, et al. The D-Net diabetes self-management program: long-term implementation, outcomes, and generalization results. Prev Med. 2003;36:410–9. doi:10.1016/S0091-7435(02)00056-7.
Newman S, Steed L, Mulligan K. Self-management interventions for chronic illness. Lancet. 2004;364:1523–37.
U.S. Centers for Disease Control and Prevention. National diabetes fact sheet: national estimates and general information on diabetes and prediabetes in the United States, 2011. US Dep Heal Hum Serv Centers Dis Control Prev. 2011;3:1–12.
Diabetes Control and Complications Trial Research Group. Effect of intensive diabetes management on macrovascular events and risk factors in the diabetes control and complications trial. Am J Cardiol. 1995;75:894–903. doi:10.1016/S0002-9149(99)80683-3.
Stratton IM, Adler AI, Neil HAW, et al. Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study. Br Med J. 2000;321:405–12.
American Diabetes Association. Standards of medical care in diabetes-2015. Diabetes Care. 2015;38:S1–94.
Feldman BS, Cohen-Stavi CJ, Leibowitz M, et al. Defining the role of medication adherence in poor glycemic control among a general adult population with diabetes. PLoS One. 2014;9:e108145.
Hood KK, Peterson CM, Rohan JM, Drotar D. Association between adherence and glycemic control in pediatric type 1 diabetes: a meta-analysis. Pediatrics. 2009;124:e1171–9. doi:10.1542/peds.2009-0207.
Ho PM, Rumsfeld JS, Masoudi FA, et al. Effect of medication nonadherence on hospitalization and mortality among patients with diabetes mellitus. Arch Intern Med. 2006;166:1836–41. doi:10.1001/archinte.166.17.1836.
DiMatteo MR. Variations in patients’ adherence to medical recommendations: a quantitative review of 50 Years of research. Med Care. 2004;42:200–9. doi:10.1097/01.mlr.0000114908.90348.f9.
Nicolucci A, Kovacs Burns K, Holt RIG, et al. Diabetes attitudes, wishes and needs second study (DAWN2TM): cross-national benchmarking of diabetes-related psychosocial outcomes for people with diabetes. Diabet Med. 2013;30:767–77. doi:10.1111/dme.12245.
Russell LB, Dong-Churl S, Safford MA. Time requirements for diabetes self-management: too much for many? J Fam Pract. 2005;54:52–6.
Casagrande SS, Fradkin JE, Saydah SH, et al. The prevalence of meeting A1C, blood pressure, and LDL goals among people with diabetes, 1988–2010. Diabetes Care. 2013;36:2271–9. doi:10.2337/dc12-2258.
Anderson RJ, Freedland KE, Clouse RE, Lustman PJ. The prevalence of comorbid depression in adults with diabetes. Diabetes Care. 2001;24:1069–78. doi:10.2337/diacare.24.6.1069.
Ali S, Stone MA, Peters JL, et al. The prevalence of co-morbid depression in adults with type 2 diabetes: a systematic review and meta-analysis. Diabet Med. 2006;23:1165–73. doi:10.1111/j.1464-5491.2006.01943.x.
Roy T, Lloyd CE, Pouwer F, et al. Screening tools used for measuring depression among people with Type 1 and Type 2 diabetes: a systematic review. Diabet Med. 2012;29:164–75. doi:10.1111/j.1464-5491.2011.03401.x.
Fisher L, Skaff MM, Mullan JT, et al. Clinical depression versus distress among patients with type 2 diabetes. Diabetes Care. 2007;30:542–8. doi:10.2337/dc06-1614.
Gonzalez JS, Safren SA, Cagliero E, et al. Depression, self-care, and medication adherence in type 2 diabetes: relationships across the full range of symptom severity. Diabetes Care. 2007;30:2222–7. doi:10.2337/dc07-0158.
Li C, Barker L, Ford ES, et al. Diabetes and anxiety in US adults: findings from the 2006 behavioral risk factor surveillance system. Diabet Med. 2008;25:878–81. doi:10.1111/j.1464-5491.2008.02477.x.
Fisher L, Skaff MM, Mullan JT, et al. A longitudinal study of affective and anxiety disorders, depressive affect and diabetes distress in adults with type 2 diabetes. Diabet Med. 2008;25:1096–101. doi:10.1111/j.1464-5491.2008.02533.x.
Lin EHB, Von Korff M, Alonso J, et al. Mental disorders among persons with diabetes—results from the World Mental Health Surveys. J Psychosom Res. 2008;65:571–80. doi:10.1016/j.jpsychores.2008.06.007.
Jones JM, Lawson ML, Daneman D, et al. Eating disorders in adolescent females with and without type 1 diabetes: cross sectional study. BMJ. 2000;320:1563–6. doi:10.1136/bmj.320.7249.1563.
Papelbaum M, Appolinário J, Moreira R, et al. Prevalence of eating disorders and psychiatric comorbidity in a clinical sample of type 2 diabetes mellitus patients. Rev Bras Psiquiatr. 2005;27:135–8.
Hudson J, Hiripi E, Pope HJ, Kessler R. The prevalence and correlates of eating disorders in the National Comorbidity Survey Replication. Biol Psychiatry. 2007;61:348–58. doi:10.1016/j.biopsych.2006.03.040.
Herpertz S, Albus C, Wagener R, et al. Comorbidity of diabetes and eating disorders: does diabetes control reflect disturbed eating behavior? Diabetes Care. 1998;21:1110–6. doi:10.2337/diacare.21.7.1110.
Crow S, Kendall D, Praus B, Thuras P. Binge eating and other psychopathology in patients with type II diabetes mellitus. Int J Eat Disord. 2001;30:222–6.
Mannucci E, Tesi F, Ricca V, et al. Eating behavior in obese patients with and without type 2 diabetes mellitus. Int J Obes Relat Metab Disord. 2002;26:848–53. doi:10.1038/sj.ijo.0801976.
Carroll P, Tiggemann M, Wade T. The role of body dissatisfaction and bingeing in the self-esteem of women with type II diabetes. J Behav Med. 1999;22:59–74. doi:10.1023/A:1018799618864.
Allison K, Crow S, Reeves R, et al. Binge eating disorder and night eating syndrome in adults with type 2 diabetes. Obesity (Silver Spring). 2007;15:1287–93.
Goodwin RD, Hoven CW, Spitzer RL. Diabetes and eating disorders in primary care. Int J Eat Disord. 2003;33:85–91.
Rouillon F, Sorbara F. Schizophrenia and diabetes: epidemiological data. Eur Psychiatry. 2005;20 Suppl 4:S345–8. doi:10.1016/S0924-9338(05)80189-0.
Schoepf D, Potluri R, Uppal H, et al. Type-2 diabetes mellitus in schizophrenia: Increased prevalence and major risk factor of excess mortality in a naturalistic 7-year follow-up. Eur Psychiatry. 2012;27:33–42. doi:10.1016/j.eurpsy.2011.02.009.
Kilbourne AM, Cornelius JR, Han X, et al. Burden of general medical conditions among individuals with bipolar disorder. Bipolar Disord. 2004;6:368–73. doi:10.1111/j.1399-5618.2004.00138.x.
Polonsky WH, Fisher L, Earles J, et al. Assessing psychosocial distress in diabetes: development of the diabetes distress scale. Diabetes Care. 2005;28:626–31.
Deschês SS, Burns RJ, Schmitz N. Associations between diabetes, major depressive disorder and generalized anxiety disorder comorbidity, and disability: findings from the 2012 Canadian Community Health Survey-Mental Health (CCHS-MH). J Psychosom Res. 2015;78:137–42.
Mollema ED, Snoek FJ, Heine RJ, Van Der Ploeg HM. Phobia of self-injecting and self-testing in insulin-treated diabetes patients: opportunities for screening. Diabet Med. 2001;18:671–4. doi:10.1046/j.1464-5491.2001.00547.x.
Weinger K, Lee J. Psychosocial and psychiatric challenges of diabetes mellitus. Nurs Clin North Am. 2006;41:667–80. doi:10.1016/j.cnur.2006.07.002.
Gonzalez JS, Esbitt SA, Schneider HE, et al. Psychological issues in adults with type 2 diabetes. Psychological co-morbidities of physical illness. New York: Springer; 2011. p. 73–121.
Gonzalez JS, Hood KK, Esbitt SA, et al. Psychiatric and psychosocial issues among individuals living with diabetes. Diabetes in America. 2nd ed. NIDDK; in press.
Gonzalez JS, Peyrot M, McCarl LA, et al. Depression and diabetes treatment nonadherence: a meta-analysis. Diabetes Care. 2008;31:2398–403. doi:10.2337/dc08-1341.
Aikens JE. Prospective associations between emotional distress and poor outcomes in type 2 diabetes. Diabetes Care. 2012;35:2472–8. doi:10.2337/dc12-0181.
Tsigos C, Chrousos GP. Hypothalamic-pituitary-adrenal axis, neuroendocrine factors and stress. J Psychosom Res. 2002;53(4):865–71.
Zanoveli JM, de Morais H, de Silva Dias IC, et al. Depression associated with diabetes: from pathophysiology to treatment. Curr Diabetes Rev. 2015;11:1–11.
Stetler C, Miller GE. Depression and hypothalamic-pituitary-adrenal activation: a quantitative summary of four decades of research. Psychosom Med. 2011;73:114–26.
Leventhal H, Leventhal EA, Contrada RJ. Self-regulation, health, and behavior: a perceptual-cognitive approach. Psychol Health. 1998;13:717–33. doi:10.1080/08870449808407425.
Horne R, Chapman SCE, Parham R, et al. Understanding patients’ adherence-related beliefs about medicines prescribed for long-term conditions: a meta-analytic review of the Necessity-Concerns Framework. PLoS One. 2013;8(12):e80633. doi:10.1371/journal.pone.0080633.
Mc Sharry J, Moss-Morris R, Kendrick T. Illness perceptions and glycaemic control in diabetes: a systematic review with meta-analysis. Diabet Med. 2011;28:1300–10. doi:10.1111/j.1464-5491.2011.03298.x.
Brown AF, Ettner SL, Piette J, et al. Socioeconomic position and health among persons with diabetes mellitus: a conceptual framework and review of the literature. Epidemiol Rev. 2004;26:63–77. doi:10.1093/epirev/mxh002.
Sclar DA, Robison LM, Skaer TL, Galin RS. Trends in the prescribing of antidepressant pharmacotherapy: office-based visits, 1990–1995. Clin Ther. 1998;20:871–84. doi:10.1016/S0149-2918(98)80148-3.
MacGillivray S, Arroll B, Hatcher S, et al. Efficacy and tolerability of selective serotonin reuptake inhibitors compared with tricyclic antidepressants in depression treated in primary care: systematic review and meta-analysis. BMJ. 2003;326:1014. doi:10.1136/bmj.326.7397.1014.
Goodnick PJ, Henry JH, Buki VM. Treatment of depression in patients with diabetes mellitus. J Clin Psychiatry. 1995;56:128–36.
Ye Z, Chen L, Yang Z, et al. Metabolic effects of fluoxetine in adults with type 2 diabetes mellitus: a meta-analysis of randomized placebo-controlled trials. PLoS One. 2011;6(7):e21551. doi:10.1371/journal.pone.0021551.
Thase ME, Haight BR, Richard N, et al. Remission rates following antidepressant therapy with bupropion or selective serotonin reuptake inhibitors: a meta-analysis of original data from 7 randomized controlled trials. J Clin Psychiatry. 2005;66:974–81.
Lustman PJ, Williams MM, Sayuk GS, Nix BD, Clouse RE. Factors influencing glycemic control in type 2 diabetes during acute-and maintenance-phase treatment of major depressive disorder with bupropion. Diabetes Care. 2007;30(3):459–66.
Goodnick P. Use of antidepressants in treatment of comorbid diabetes mellitus and depression as well as in diabetic neuropathy. Ann Clin Psychiatry. 2001;13:31–4.
Philip NS, Carpenter LL, Tyrka AR, Price LH. Augmentation of antidepressants with atypical antipsychotics: a review of the current literature. J Psychiatr Pract. 2008;14:34–44. doi:10.1097/01.pra.0000308493.93003.92.
Lett TAP, Wallace TJM, Chowdhury NI, et al. Pharmacogenetics of antipsychotic-induced weight gain: review and clinical implications. Mol Psychiatry. 2012;17:242–66. doi:10.1038/mp.2011.109.
Haddad PM, Sharma SG. Adverse effects of atypical antipsychotics: differential risk and clinical implications. CNS Drugs. 2007;21:911–36. doi: 21114 [pii].
Markowitz SM, Gonzalez JS, Wilkinson JL, Safren SA. A review of treating depression in diabetes: emerging findings. Psychosomatics. 2011;52:1–18. doi:10.1016/j.psym.2010.11.007.
Norris SL, Engelgau MM, Narayan KM. Effectiveness of self-management training in type 2 diabetes: a systematic review of randomized controlled trials. Diabetes Care. 2001;24:561–87. doi:10.2337/diacare.24.3.561.
Fisher L, Hessler D, Glasgow RE, et al. REDEEM: a pragmatic trial to reduce diabetes distress. Diabetes Care. 2013;36:2551–8. doi:10.2337/dc12-2493.
Bell AC, D’Zurilla TJ. Problem-solving therapy for depression: a meta-analysis. Clin Psychol Rev. 2009;29:348–53. doi:10.1016/j.cpr.2009.02.003.
Hill-Briggs F, Gemmell L. Problem solving in diabetes self-management and control: a systematic review of the literature. Diabetes Educ. 2007;33:1032–50. doi:10.1177/0145721707308412; discussion 1051–2.
Fitzpatrick SL, Schumann KP, Hill-Briggs F. Problem solving interventions for diabetes self-management and control: a systematic review of the literature. Diabetes Res Clin Pract. 2013;100:145–61. doi:10.1016/j.diabres.2012.12.016.
Safren SA, Gonzalez JS, Soroudi N. Coping with chronic illness, therapist guide. New York: Oxford University Press; 2007.
Safren SA, Gonzalez JS, Wexler DJ, et al. A randomized controlled trial of cognitive behavioral therapy for adherence and depression (CBT-AD) in patients with uncontrolled type 2 diabetes. Diabetes Care. 2014;37:625–33. doi:10.2337/dc13-0816.
Markowitz SM, Carper MM, Gonzalez JS, Delahanty LM, Safren SA. Cognitive-behavioral therapy for the treatment of depression and adherence in patients with type 1 diabetes: pilot data and feasibility. Prim Care Companion CNS Disord. 2012;14(2).
Esbitt SA, Batchelder AW, Tanenbaum ML, et al. “Knowing That You’re Not the Only One”: perspectives on group-based cognitive-behavioral therapy for adherence and depression (CBT-AD) in adults with type 1 diabetes. Cogn Behav Pract. 2014;22(3):393–406. doi:10.1016/j.cbpra.2014.02.006.
Soroudi N, Perez GK, Gonzalez JS, et al. CBT for Medication Adherence and Depression (CBT-AD) in HIV-infected patients receiving methadone maintenance therapy. Cogn Behav Pract. 2008;15:93–106. doi:10.1016/j.cbpra.2006.11.004.
Safren SA, O’Cleirigh C, Tan JY, et al. A randomized controlled trial of cognitive behavioral therapy for adherence and depression (CBT-AD) in HIV-infected individuals. Health Psychol. 2009;28:1–10. doi:10.1037/a0012715.
Gonzalez JS, McCarl LA, Wexler DJ, et al. Cognitive–behavioral therapy for adherence and depression (CBT-AD) in type 2 diabetes. J Cogn Psychother. 2010;24:329–43. doi:10.1891/0889-8391.24.4.329.
Safren SA, O’Cleirigh CM, Bullis JR, et al. Cognitive behavioral therapy for adherence and depression (CBT-AD) in HIV-infected injection drug users: a randomized controlled trial. J Consult Clin Psychol. 2012;80:404–15. doi:10.1037/a0028208.
Simoni JM, Wiebe JS, Sauceda JA, et al. A preliminary RCT of CBT-AD for adherence and depression among HIV-positive latinos on the U.S.-Mexico border: the Nuevo Dia study. AIDS Behav. 2013;17:2816–29. doi:10.1007/s10461-013-0538-5.
Berg C, Raminani S, Greer J, et al. Participants’ perspectives on cognitive-behavioral therapy for adherence and depression in HIV. Psychother Res. 2008;18:271–80. doi:10.1080/10503300701561537.
Safren SA, Gonzalez JS, Soroudi N. Coping with chronic illness, workbook. New York: Oxford University Press; 2007.
Miller W, Rollnick S. Motivational interviewing, helping people change. 3rd ed. New York: Guilford; 2013.
Harvey JN. Psychosocial interventions for the diabetic patient. Diabetes Metab Syndr Obes. 2015;8:29–43.
Safren SA, Otto MW, Worth JL, et al. Two strategies to increase adherence to HIV antiretroviral medication: life-steps and medication monitoring. Behav Res Ther. 2001;39:1151–62. doi:10.1016/S0005-7967(00)00091-7.
Linehan M. Skills training manual for treating borderline personality disorder. New York: Guilford; 1993.
Beck AT. Cognitive therapy of depression. New York: Guilford; 1979.
Beck JS. Cognitive behavior therapy: basics and beyond. 2nd ed. New York: Guilford; 2011.
D’Zurilla TJ. Problem-solving therapy: a positive approach to clinical intervention. 3rd ed. New York: Springer; 2007.
Cotanch P. Relaxation training for control of nausea and vomiting in patients receiving chemotherapy. Cancer Nurs. 1983;6:277–83.
Turner J, Chapman C. Psychological intervention for chronic pain: a critical review-relaxation and biofeedback. Pain. 1982;12:1–221.
Smith W. Biofeedback and relaxation training: the effect on headache and associated symptoms. Headache. 1987;27:511–4.
Ost L. Applied Relaxation: manual for a behavioral coping technique. Department of Psychology, Stockholm University.
Otto M, Jones J, Craske M, Barlow D. Stopping anxiety medication: panic control therapy for benzodiazepine discontinuation (therapist guide). San Antonio: Psychological Corporation; 1996.
Tanenbaum ML, Ritholz MD, Binko DH, et al. Probing for depression and finding diabetes: a mixed-methods analysis of depression interviews with adults treated for type 2 diabetes. J Affect Disord. 2013;150:533–9. doi:10.1016/j.jad.2013.01.029.
Tanenbaum ML, Gonzalez JS. The influence of diabetes on a clinician-rated assessment of depression in adults with type 1 diabetes. Diabetes Educ. 2012;38:695–704. doi:10.1177/0145721712452795.
Fisher L, Glasgow RE, Mullan JT, et al. Development of a brief diabetes distress screening instrument. Ann Fam Med. 2008;6:246–52. doi:10.1370/afm.842.
Fisher L, Hessler D, Polonsky WH, Mullan J. When is diabetes distress meaningful? Establishing cut points for the diabetes distress scale. Diabetes Care. 2012;35:259–64.
Weinger K, Butler HA, Welch GW, La Greca AM. Measuring diabetes self-care: a psychometric analysis of the Self-Care Inventory-Revised with adults. Diabetes Care. 2005;28:1346–52.
La Greca A. Manual for the self care inventory. Miami: University of Miami; 2004.
Khagram L, Martin CR, Davies MJ, Speight J. Psychometric validation of the Self-Care Inventory-Revised (SCI-R) in UK adults with type 2 diabetes using data from the AT.LANTUS follow-on study. Health Qual Life Outcomes. 2013;11:24. doi:10.1186/1477-7525-11-24.
Gonzalez JS, Schneider HE. Methodological issues in the assessment of diabetes treatment adherence. Curr Diab Rep. 2011;11(6):472–9.
Gonzalez JS, Schneider HE, Wexler DJ, et al. Validity of medication adherence self-reports in adults with type 2 diabetes. Diabetes Care. 2013;36:831–7. doi:10.2337/dc12-0410.
Chomutare T, Fernandez-Luque L, Arsand E, Hartvigsen G. Features of mobile diabetes applications: review of the literature and analysis of current applications compared against evidence-based guidelines. J Med Internet Res. 2011;13(3):e65. doi:10.2196/jmir.1874.
Wilson IB, Fowler Jr FJ, Cosenza CA, Michaud J, Bentkover J, Rana A, Kogelman L, Rogers WH. Cognitive and field testing of a new set of medication adherence self-report items for HIV care. AIDS Behav. 2014;18(12):2349–58.
United Kingdom Prospective Diabetes Study (UKPDS) Group. United Kingdom Prospective Diabetes Study (UKPDS). 13: Relative efficacy of randomly allocated diet, sulphonylurea, insulin, or metformin in patients with newly diagnosed non-insulin dependent diabetes followed for three years. BMJ. 1995;310:83–8. doi:10.1136/bmj.310.6972.83.
Hermanns N, Schmitt A, Gahr A, et al. The effect of a diabetes-specific cognitive behavioral treatment program (DIAMOS) for patients with diabetes and subclinical depression: results of a randomized controlled trial. Diabetes Care. 2015;38(4):551–60. doi:10.2337/dc14-1416.
Chen S, Creedy D, Lin H, Wollin J. Effects of motivational interviewing intervention on self-management, psychological and glycemic outcomes in type 2 diabetes: a randomized controlled trial. Int J Nurs Stud. 2012;49:637–44.
Gabbay RRA, Añel-Tiangco R, Dellasega C, et al. Diabetes nurse case management and motivational interviewing for change (DYNAMIC) results of a 2-year randomized control pragmatic trial. J Diabetes. 2013;5:349–57.
Welschen L, van Oppen P, Dekker J, et al. Effects of a cognitive behavioural treatment in patients with type 2 diabetes when added to managed care; a randomised controlled trial. BMC Public Health. 2007;7:74.
Huffman JC, DuBois CM, Millstein RA, et al. Positive psychological interventions for patients with type 2 diabetes: rationale, theoretical model, and intervention development. J Diabetes Res. 2015;2015:428349. doi:10.1155/2015/428349.
Fisher L, Gonzalez JS, Polonsky WH. The confusing tale of depression and distress in patients with diabetes: a call for greater clarity and precision. Diabet Med. 2014;31:764–72. doi:10.1111/dme.12428.
Montgomery SA, Asberg MA. A new depression scale designed to be sensitive to change. The British journal of psychiatry. 1979 Apr 1;134(4):382–9.
Additional Resources
Safren S, Gonzalez J, Soroudi N. Coping with chronic illness: a cognitive-behavioral approach for adherence and depression therapist guide. New York: Oxford University Press; 2008.
Safren S, Gonzalez J, Soroudi N. Coping with chronic illness: a cognitive-behavioral approach for adherence and depression client workbook. New York: Oxford University Press; 2007.
Lloyd CE, Pouwer F, Hermanns N, editors. Screening for depression and other psychological problems in diabetes: a practical guide. New York: Springer; 2012.
Katon W, Maj M, Sartorius N, editors. Depression and diabetes, vol. 16. New York: Wiley; 2011.
Polonsky W. Diabetes burnout: what to do when you can’t take it anymore. Alexandria: American Diabetes Association; 1999.
Rubin R. Psyching out diabetes: a positive approach to your negative emotions. Los Angeles: Lowell House; 1993.
Young-Hymam D, Peyrot M. Psychosocial care for people with diabetes. Washington, DC: American Diabetes Association; 2012.
American Diabetes Association. American Diabetes Association complete guide to diabetes. New York: McGraw-Hill/Contemporary; 2011.
American Diabetes Association (ADA). http://www.diabetes.org/
National Diabetes Education Program’s (NDEP). http://ndep.nih.gov/
Behavioral Diabetes Institute. http://www.behavioraldiabetesinstitute.org/
Promoting Medication Adherence in Diabetes (NDEP Web Resource): https://www.niddk.nih.gov/health-information/health-communication-programs/ndep/health-care-professionals/medication-adherence/Pages/default.aspx
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Gonzalez, J.S., Kane, N.S., Chang, T.E. (2017). Cognitive Behavioral Therapy for Adherence and Depression in Diabetes. In: Vranceanu, AM., Greer, J., Safren, S. (eds) The Massachusetts General Hospital Handbook of Behavioral Medicine. Current Clinical Psychiatry. Humana Press, Cham. https://doi.org/10.1007/978-3-319-29294-6_6
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