U.S. Department of Veterans Affairs


Date of this Version


Document Type



Diabetes Research and Clinical Practice, 79 (2008) 37-41; doi:10.1016/j.diabres.2007.06.012


Objective: Diabetes mellitus is a major public health problem with a prevalence of 6–7%. Self-care behaviors play a major role in the control of diabetes. Apathy is characterized by loss of initiative and motivation. Apathy may interfere with self-care behavior and glycemic control. The primary objective was to determine the prevalence of apathy in patients with diabetes. The secondary objective was to determine if there was an association between clinically significant apathy and factors that affect glycemic control.

Research design and methods: We conducted a cross-sectional study of 100 patients with diabetes who were assessed with the Apathy Evaluation Scale-Clinician version (AES-C), the Hamilton Depression Scale (HAM-D), and the Self-Care Inventory (SCI). For this study we defined clinically significant apathy as AES-C score of >30. We excluded patients with a HAM-D score of >14 (n = 19) to avoid confounding from depression. T-tests were used to compare clinical characteristics between subjects with and without apathy. Multiple linear regression modeling was used to investigate the association between clinically significant apathy and factors that affect glycemic control.

Results: Fifty (61.7% of 81) patients had clinically significant apathy. Compared to the nonapathetic patients, those with apathy had a higher mean BMI (30.5 kg/m2 versus 34.1 kg/m2 (p = 0.03)) and were less likely to adhere to an exercise plan (p = 0.01) or insulin regimen (p = 0.003). After adjustment for age, BMI, cholesterol, mild depression and the average Self- Care Index score, the mean HbA1C level was 0.66% greater for apathetic compared to nonapathetic subjects (P = 0.08).

Conclusion: Apathy is highly prevalent in patients with diabetes without depression. Apathy may have a negative impact on self-care behaviors and diabetes control.