Article Summary Relationship of Depression and Diabetes Self-Care, Medication Adherence, and Preventive Care. Lin EHB, Katon W, Von Korff M, Rutter C, Simon GE, Oliver M, Ciechanowski P, Ludman EJ, Bush T, Young B. Diabetes Care. 2004;27:2154-2160. Objective: To ascertain the relationship between major depression and compliance with treatment, self-care, and clinical outcomes in patients with type 2 diabetes. Methods: A population-based, epidemiologic survey was conducted between 2001 and 2003 in 9 staff-model primary care clinics with a large number of patients with diabetes. Patients were enrollees of a health maintenance organization in Seattle, Washington. Inclusion criteria for the diabetes registry included patients taking any diabetic agent; fasting glucose of =126 mg/dL confirmed by a second test within 1 year; random plasma glucose =200 mg/dL confirmed by a second test within 1 year; or a hospital discharge diagnosis of diabetes. A revised version of the Summary of Diabetes Self-Care Activities was mailed to 4500 patients with diabetes; 62% of patients responded. Findings were assessed in reference to patients who performed specific self-care activities once weekly or less. Computerized pharmacy refill data were used to assess adherence to pharmacotherapy regimens, including oral hypoglycemic, lipid-lowering, or antihypertensive agents. Patient-reported days of noncompliance were labeled as nonadherent days. The Patient Health Questionnaire was used to assess depression in this population. Results: Nearly 50% of responders reported engaging in exercise only once a week or less; 10% reported that they rarely followed a healthy diet plan; 25% reported infrequent self-monitoring of blood glucose. On average, patients were nonadherent to oral hypoglycemic medications 64.7 ± 74.1 days during the prior year. Although the American Diabetes Association recommends that A1C levels be checked 4 times per year, the survey results showed the mean number of A1C tests in the prior year to be 2.2. Major depression was present in 12% of this sample and was more prevalent in women with diabetes than in men with diabetes (14.4% versus 9.8%). Patients with major depression were more likely to be nonadherent to self-care activities compared with patients without major depression. Depressed patients were nonadherent to oral hypoglycemic agents 80 days in the prior year compared with 62 days for nondepressed patients. Conclusion: Lack of physical activity, high nonadherence rates to oral hypoglycemic agents, and clinical monitoring that does not meet American Diabetes Association recommendations are 3 notable deficiencies in diabetes management in this study sample. In addition, patients with diabetes who have comorbid depression have higher rates of nonadherence to medication and self-care activities than do patients with diabetes who are not depressed. Results imply a need to integrate depression screening and treatment into diabetes management regimens.