The effectiveness of depression care management on diabetes-related outcomes in older patients

Ann Intern Med. 2004 Jun 15;140(12):1015-24. doi: 10.7326/0003-4819-140-12-200406150-00012.

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 A(1c) 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.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Aged
  • Antidepressive Agents / therapeutic use
  • Depression / therapy*
  • Diabetes Mellitus / blood
  • Diabetes Mellitus / psychology*
  • Female
  • Glycated Hemoglobin A / metabolism
  • Health Behavior
  • Humans
  • Male
  • Patient Compliance
  • Psychotherapy
  • Self Care
  • Treatment Outcome

Substances

  • Antidepressive Agents
  • Glycated Hemoglobin A