Integrated care model to lower depressive, heart issues in diabetics

The study published in Journal of the American Medical Association on Integrating Depression and Diabetes Treatment found that a low-cost one-year integrated or “collaborative” care model delivered in diabetes clinics can lower depressive symptoms and improve cardiometabolic health.

The study compared an integrated collaborative care model with usual care among 404 patients with diabetes and moderate-to-severe depressive symptoms. These patients were attending four diverse diabetes clinics, one government and three private hospitals in India over a two-year period and found major improvements in the group receiving the integrated approach.

The first author of the study and principal investigator, Dr Mohammed Ali, Associate Professor of Global Health and Epidemiology at the Rollins School of Public Health, said, “People with diabetes have a higher risk of experiencing depression, which worsens their likelihood of managing their diabetes well, resulting in a higher risk of heart attacks and other diabetes complications and mortality. Too often, mental health is overlooked due to fragmented care, stigma of psychiatric illnesses, and shortages of mental health professions.”

The study also stated that fragmentation of health is common but is especially pronounced in low- and middle-income countries like India or under-resourced and under-served regions in the United States. Improvements in cardiometabolic parameters were seen after the active one-year period which thereby suggested the need for continued support for blood sugar, blood pressure and cholesterol levels.

The senior author of the study Dr Viswanathan Mohan, Director, Madras Diabetes Research Foundation, said, “This was the first study to determine if a one-year integrated, collaborative care model has sustainable effects at two years. Due to the shortage of psychiatrists in India, we used care coordinators who were specially trained to screen and provide counselling for depression. This low-cost model produced impressive results both in improving depression as well as in several metabolic parameters and can be useful in other scenarios and countries.”