A joint Indo-U.S. research study found that integrating depression and diabetes treatment (‘INDEPENDENT’) improved parameters for both conditions. The study was published in a recent issue of the the peer-reviewed journal JAMA.
The study, performed over a one-year period and followed up at the end of the second year, found that a low-cost one-year collaborative care model delivered in diabetes clinics can lower depressive symptoms and improve cardio metabolic health at the same time.
The study was a collaboration between Emory University, Atlanta and the University of Washington, Seattle; the All India Institute of Medical Sciences, Delhi; Madras Diabetes Research Foundation (MDRF), Chennai; Diacon Hospital, Bengaluru, and Endocrine and Diabetes Centre, Visakhapatnam, and was funded by the National Institutes for Health, U.S.
Researchers compared an integrated care model with regular 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) in India over a two-year period.
Mohammed Ali, principal investigator, 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 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.”
V. Mohan of the MDRF, explained: “The key takeaway from the study was that we should not work in silos. Depression and diabetes have a bi-directional relationship, impacting on each other. Depression causes counter regulatory hormones to be secreted — adrenaline and noradrenaline — which nullify the effect of insulin on the body.” This study has showed that treating both together has an ameliorative impact on both diabetes and depression among patients.
Due to the shortage of psychiatrists in India, the researches worked with care coordinators who were specially trained to screen and provide counselling for depression. Everyone who came to the clinic was screened for depression using a standard questionnaire, Dr. Mohan said. That helped identify if people were depressed and also where they stood with their condition — mild, moderate or severe.
“We developed a simple electronic health record with decision-support prompts (based on evidence-based guidelines) to assist clinicians in prescribing interventions,” he said. Attesting to the support provided by this e-health record, G. R. Sridhar of the Endocrine and Diabetes Centre, said it made sure that the intervention was low cost and would be sustainable. “There was definite improvement in both depression and metabolic scores at the end of one year of active intervention,” he said. The difference in reaching the intended target between the control arm and intervention arm of the trial was at least 16%, marking a significant impact of the latter, Dr. Mohan added.
However, researchers found that improvements in cardio metabolic parameters waned after the active one-year period which thereby suggested the need for continued support for blood sugar, blood pressure and cholesterol levels.