Research & Program Areas

The Positive Steps Study

Patients with diabetes and depression often have self-management needs that require between-visit support. This study led by CMCD Director, John Piette, PhD, evaluated the impact of telephone-delivered cognitive behavioral therapy (CBT) targeting patients’ management of depressive symptoms, physical activity levels, and diabetes-related outcomes. Two hundred ninety-one patients with type 2 diabetes and significant depressive symptoms were recruited from a community-based, university-based, and Veterans Affairs health care systems. A manualized telephone CBT program was delivered weekly by nurses for 12 weeks, followed by 9 monthly booster sessions. Sessions initially focused exclusively on patients’ depression management and then added a pedometer-based walking program.

The primary outcome was hemoglobin A1c levels measured at 12 months. Blood pressure was a secondary outcome; levels of physical activity were determined by pedometer readings; depression, coping, and health-related quality of life were measured using standardized scales. Baseline A1c levels were relatively good and there was no difference in A1c at follow-up. However, intervention patients experienced a 4.26 mm Hg decrease in systolic blood pressure relative to controls. Intervention patients had significantly greater increases in step counts and greater reductions in depressive symptoms. Intervention patients also experienced relative improvements in coping and health-related quality of life.

For more information, contact Nicolle Marinec at


Depression, Diabetes, Multiple Chronic Conditions, Telephone, Veterans

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