Integrating Type 2 Diabetes Mellitus and Depression Treatment Among African Americans A Randomized Controlled Pilot Trial

Hillary R. Bogner, MSCE, Department of Family Medicine and Community Health, School of Medicine, The University of Pennsylvania, 3400 Spruce Street, 2 Gates Building, Philadelphia, PA 19104, USA.
The Diabetes Educator (Impact Factor: 1.79). 03/2010; 36(2):284-92. DOI: 10.1177/0145721709356115
Source: PubMed


The purpose of this study was to examine whether integrating depression treatment into care for type 2 diabetes mellitus among older African Americans improved medication adherence, glycemic control, and depression outcomes.
Older African Americans prescribed pharmacotherapy for type 2 diabetes mellitus and depression from physicians at a large primary care practice in west Philadelphia were randomly assigned to an integrated care intervention or usual care. Adherence was assessed at baseline, 2, 4, and 6 weeks using the Medication Event Monitoring System to assess adherence. Outcomes assessed at baseline and 12 weeks included standard laboratory tests to measure glycemic control and the Center for Epidemiologic Studies Depression Scale (CES-D) to assess depression.
In all, 58 participants aged 50 to 80 years participated. The proportion of participants who had 80% or greater adherence to an oral hypoglycemic (intervention 62.1% vs usual care 24.1%) and an antidepressant (intervention 62.1% vs usual care 10.3%) was greater in the intervention group in comparison with the usual care group at 6 weeks. Participants in the integrated care intervention had lower levels of glycosylated hemoglobin (intervention 6.7% vs usual care 7.9%) and fewer depressive symptoms (CES-D mean scores: intervention 9.6 vs usual care 16.6) compared with participants in the usual care group at 12 weeks.
A pilot randomized controlled trial integrating type 2 diabetes mellitus treatment and depression was successful in improving outcomes among older African Americans. Integrated interventions may be more feasible and effective in real-world practices with competing demands for limited resources.

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    • "HbA1c values were not affected at 6 months, 12 months and the end of follow up. Of the trials included in qualitative synthesis, three of them [19,26,27] had found that collaborative care was associated with improved HbA1c values, and two of them was significant [19,26]. Given that diabetic patients with depression usually have more macrovascular and microvascular complications and higher numbers of risk factors than diabetic patients without depression, the collaborative care that focuses on improving management of both depression and diabetes are likely to be needed in the future, to improve clinical outcomes at a population level in both of chronic illnesses [19]. "
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    ABSTRACT: The combination of depression and diabetes is common and especially harmful because depression has a strong impact on psychosocial as well as medical outcomes in patients with diabetes. Consequently, treatment for depression in diabetes is also aimed at improvement in glycemic control and risk reduction for diabetes complications and mortality. This review provides an overview of all published, randomized controlled trials on the treatment of depression in patients with diabetes and summarizes current, ongoing research. The best results for medical and psychological outcomes were observed for psychological treatments; however, the generalizability of these results is restricted by methodological limitations. Most antidepressants were effective treatments for depression in diabetes but failed to show benefits regarding diabetes-related medical variables. Algorithm-based care, including psychological and psychopharmacological approaches, provides the best scientific evidence for successful depression treatment but not for glycemic control. Depression can be treated with antidepressants, psychotherapy or a flexible combination of both with relatively good results that are comparable to those for patients who have depression but not diabetes. Up to now, no single treatment that consistently leads to better medical outcomes in patients with both depression and diabetes has been clearly identified.
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    ABSTRACT: Research suggests individuals with diabetes are twice as likely as those without diabetes to be clinically depressed. Still unknown is the relationship between diabetes and depression in socioeconomically disadvantaged populations. We examined the relationship between diabetes and depressive symptoms in a large, racially diverse, low-income cohort in the southeastern USA. A total of 69,068 adults were recruited from community health centers in 12 southeastern states. A fully adjusted polytomous logistic regression model tested the relationship between demographics, lifestyle behaviors, antidepressant use, body mass index, diabetes diagnosis, diabetes duration, diabetes medication compliance, and depressive symptoms using the Centers for Epidemiological Studies Depression scale. Diabetes was present in 21.7% of sample. While a diabetes diagnosis was associated with having severe depressive symptoms (AOR, 1.24; 95% CI, 1.14-1.34), demographics, lifestyle behaviors, body mass index and antidepressant use were more strongly associated with severe depressive symptoms than a diabetes diagnosis. Having diabetes was associated with the presence and severity of depressive symptoms in a large, low-income sample of racially diverse adults. However, the relationship between diabetes and depressive symptoms was weaker than in other studies with higher socioeconomic groups.
    Annals of Behavioral Medicine 11/2010; 41(3):300-9. DOI:10.1007/s12160-010-9241-1 · 4.20 Impact Factor
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