African-Americans suffer from increased prevalence of both type 2 diabetes and diabetes
complications, reflecting a combination of psychobehavioral factors as well as metabolic
dysfunction. In this process, depression may contribute to both the genesis of type 2
diabetes (through impact on neurohormonal activation, inflammatory mediators, and insulin
resistance), and difficulties in management (through decreased adherence to diet plans,
medication, and scheduled appointments). The preliminary data from the Grady Diabetes Clinic
indicates that depression may be common in African-Americans with diabetes, that depression
is a factor in non-adherence, and that non-adherence leads to poor glycemic control - a
direct cause of diabetes complications. What is not known is: how treatment of depression
could lead to both neurohormonal and psychobiological improvement, with improved patient
adherence and glycemic control.