Case Study: Assessing the relationship between depression, obesity, and HbA1c levels


With careful assessment, it can be found that diabetic patients who are noncompliant with their treatment, as evident by rising HbA1c levels, are usually also depressed. Lack of energy, appetite, concentration and motivation are some of the significant factors, which can lead to missing their office visits. Keeping a low profile, lacking in physical activity, and generally leading a sedentary lifestyle all contribute to these patients’ obesity. Diabetic patients tend to have a larger appetite, and easy access to fast food with lots of calories increases their fat intake, consequently increasing their HbA1c levels.

Doctors can monitor their noncompliant patients through their symptoms and lab results. We can also assess patients’ depression using the PHQ-9 scale. Patients with a score of 10-14 on the PHQ scale are candidates to be considered for antidepressant drugs or psychotherapy.

Criteria for selection of patients in this study:

  • Age 18 to 80 years
  • Male or female
  • Suffering from diabetes mellitus
  • Comorbidities like obesity, depression
  • Patients with other comorbidities were also included, such as those with hypertension, CAD, chronic kidney disease, and COPD

Modality of treatment used:

  • Diet counseling
  • Obesity counseling
  • Common antidepressants (SSRIs, Bupropion)
  • Smoking and alcohol counseling


While practicing as a physician in India, I came across many patients who were extremely noncompliant, not only with the antidiabetic treatment, but also with office visits. While working here in the U.S. on the Healthcare Effectiveness Data and Information Set, I saw a rising trend in HbA1c levels, which in turn were affecting patients’ hearts, kidneys, eyes and other vital organs at a very young age. When I searched further into the patients’ clinical history and spoke to them, I learned that most of them were not happy with their life or work, and some of them had cultivated habits of eating too much and leading sedentary lifestyles. Patients were not concerned with their diabetic status, did not follow any dietary restrictions, had no physical exercise, developed cravings for food, and ate more than their requirements. Patients started avoiding the things they used to enjoy doing most. In addition, a particular bad circumstance or situation in a patient’s family created a low disposition or feeling that the patient could not escape. This would become a vicious cycle of feeling depressed, increasing BMI or obesity, and deteriorating diabetic status in the form of rising HbA1c levels....

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