The Role of Apathy in Glycemic Control

The incidence of diabetes in the US is at epidemic proportions. A large number of diabetes patients in the VA system have uncontrolled diabetes with high HbA1c. The inability to carry out important self-care behaviors such as measuring blood sugars regularly, following diet, exercise and medication programs may be due to apathy. Apathy is the lack of motivation, persistence and novelty. We have found this to be very prevalent in the VA diabetes population. We now do a randomized placebo controlled trial to see if treatment of apathy with methylphenidate will improve glycemic control in patients with A1c >8. Treatment will be for 6 months. The primary end point is HbA1c.

Inclusion criteria

• Poor glycemic control HbA1c>8
• Presence of apathy, a score of >30 on AES
• Subjects should be on stable dose of metformin, thiozolidinediones, and sulfonylureas, statins and ACE inhibitors for at least two months
• Subjects should have a negative cardiac stress test within the previous year

Exclusion criteria

• Presence of major depressive disorder, psychosis, suicidal ideations, and history of stimulant dependence as evaluated by MINI.
• Patient currently being treated or a history hypersensitivity to methylphenidate
• Hypertension with BP>140/90
• History of renal disease with GFR<60
• History of hepatic failure with AST/ALT > three times the normal range
• History of seizure disorder, or Tourette's syndrome or presence of motor tics
• Patients with glaucoma
• Patients being treated with monoamine oxidase inhibitors (MAOIs) or Clonidine
• Patients with active cancer.
• Patients with acute illness needing hospitalization
• Patients with cardiovascular events such as myocardial infarction, stroke, amputation, unstable angina within the last six months.
• HbA1c> 12
• Planned elective surgery in next 6 months
• Pregnancy