The most common concordant comorbidity was hypertension while depression was the most common discordant condition .
Adherence to medications was the most frequent diabetes self-care behavior reported and tended to be higher among concordant comorbidities .
The findings showed mixed results concerning the effect of some concordant comorbidities such as hypertension , hyperlipidemia , retinopathy , and heart failure on diabetes self-care behaviors .
But , there is agreement across studies that diabetes-discordant comorbidities have a more detrimental effect on self-care behaviors .
Conclusions : Concordant comorbidities may improve diabetes self-care , but the evidence is inconclusive .
Background : Most patients with Type 2 diabetes ( T2D ) have high number of comorbid chronic conditions that can affect their self-care abilities .
Guidelines for diabetes self-care behaviors are disease specific with little attention given to managing T2D with other comorbidities .
Identifying comorbidities that either improve or potentially diminish the individual 's capacity to perform effective self-care behaviors is essential to enhance clinical outcomes .
One such framework conceptualizes comorbidities as concordant or discordant with diabetes pathophysiological pathways and care goals .
Objective : The purpose of this systematic review was to examine the role of diabetes-concordant and discordant chronic conditions on the performance of self-care behaviors in adults with T2D .
Depression, Self-Care, and Medication Adherence in Type 2 Diabetes
OBJECTIVE —We examined the association between depression , measured as either a continuous symptom severity score or a clinical disorder variable , with self-care behaviors in type 2 diabetes . RESEARCH DESIGN AND METHODS —We surveyed 879 type 2 diabetic patients from two primary care clinics using the Harvard Department of Psychiatry/National Depression Screening Day Scale ( H AND S ) , the Summary of Diabetes Self-Care Activities , and self-reported medication adherence . RESULTS —Of the patients , 19 % met the criteria for probable major depression ( H AND S score ≥9 ) , and an additional 66.5 % reported at least some depressive symptoms . After controlling for covariates , patients with probable major depression reported significantly fewer days ' adherent to diet , exercise , and glucose self-monitoring regimens  ( P < 0.01 ) and 2.3-fold increased odds of missing medication doses in the previous week ( 95 % CI 1.5–3.6 , P < 0.001 ) compared with all other respondents . Continuous depressive symptom severity scores were better predictors of nonadherence to diet , exercise , and medications than categorically defined probable major depression . Major depression was a better predictor of glucose monitoring . Among the two-thirds of patients not meeting the criteria for major depression ( H AND S score < 9 , n = 709 ) , increasing H AND S scores were incrementally associated with poorer self-care behaviors ( P < 0.01 ) . CONCLUSIONS —These findings challenge the conceptualization of depression as a categorical risk factor for nonadherence and suggest that even low levels of depressive symptomatology are associated with nonadherence to important aspects of diabetes self-care . Interventions aim ed at alleviating depressive symptoms , which are quite common , could result in significant improvements in diabetes self-care
The most common concordant comorbidity was hypertension while depression was the most common discordant condition .
Adherence to medications was the most frequent diabetes self-care behavior reported and tended to be higher among concordant comorbidities .
The findings showed mixed results concerning the effect of some concordant comorbidities such as hypertension , hyperlipidemia , retinopathy , and heart failure on diabetes self-care behaviors .
But , there is agreement across studies that diabetes-discordant comorbidities have a more detrimental effect on self-care behaviors .
Conclusions : Concordant comorbidities may improve diabetes self-care , but the evidence is inconclusive .
Background : Most patients with Type 2 diabetes ( T2D ) have high number of comorbid chronic conditions that can affect their self-care abilities .
Guidelines for diabetes self-care behaviors are disease specific with little attention given to managing T2D with other comorbidities .
Identifying comorbidities that either improve or potentially diminish the individual 's capacity to perform effective self-care behaviors is essential to enhance clinical outcomes .
One such framework conceptualizes comorbidities as concordant or discordant with diabetes pathophysiological pathways and care goals .
Objective : The purpose of this systematic review was to examine the role of diabetes-concordant and discordant chronic conditions on the performance of self-care behaviors in adults with T2D .