The Effectiveness of Depression Care Management on Diabetes-Related Outcomes in Older Patients

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Abstract

Background:

Depression frequently occurs in combination with diabetes mellitus, adversely affecting the course of illness.

Objective:

To determine whether enhancing care for depression improves affective and diabetic outcomes in older adults with diabetes and depression.

Design:

Preplanned subgroup analysis of the Improving Mood–Promoting Access to Collaborative Treatment (IMPACT) randomized, controlled trial.

Setting:

18 primary care clinics from 8 health care organizations in 5 states.

Patients:

1801 patients 60 years of age or older with depression; 417 had coexisting diabetes mellitus.

Intervention:

A care manager offered education, problem-solving treatment, or support for antidepressant management by the patient’s primary care physician; diabetes care was not specifically enhanced.

Measurements:

Assessments at baseline and at 3, 6, and 12 months for depression, functional impairment, and diabetes self-care behaviors. Hemoglobin A1c levels were obtained for 293 patients at baseline and at 6 and 12 months.

Results:

At 12 months, diabetic patients who were assigned to intervention had less severe depression (range, 0 to 4 on a checklist of 20 depression items; between-group difference, –0.43 [95% CI, –0.57 to –0.29]; P < 0.001) and greater improvement in overall functioning (range, 0 [none] to 10 [unable to perform activities]; between-group difference, –0.89 [CI, –1.46 to –0.32]) than did participants who received usual care. In the intervention group, weekly exercise days increased (between-group difference, 0.50 day [CI, 0.12 to 0.89 day]; P = 0.001); other self-care behaviors were not affected. At baseline, mean (±SD) hemoglobin A1c levels were 7.28% ± 1.43%; follow-up values were unaffected by the intervention (P > 0.2).

Limitations:

Because patients had good glycemic control at baseline, power to detect small but clinically important improvements in glycemic control was limited.

Conclusions:

Collaborative care improves affective and functional status in older patients with depression and diabetes; however, among patients with good glycemic control, such care minimally affects diabetes-specific outcomes.

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