Integrated approach to diabetes and depression improves both: study

PT Jyothi Datta Mumbai | Updated on August 18, 2020

Diabetes and depression often go hand in hand. But a “collaborative” care model at diabetes clinics can provide a low-cost solution not just to control diabetes but also lower depressive symptoms, says a study done in India and the United States.

Earlier studies found the prevalence of depression in the general population in India at about 15 per cent and in people with diabetes, it was about 20 per cent, Dr Viswanathan Mohan, Director with the Madras Diabetes Research Foundation (MDRF) told BusinessLine. The “collaborative care” study found that more than 70 per cent in the group receiving the integrated approach had improvements in diabetes and depression, said Dr Mohan, senior author of the study and principal investigator of the project from India.

The “Integrating Depression and Diabetes Treatment” or INDEPENDENT study stems from the team-care programme in the US that addressed the co-existence of these two illnesses, he said, adding that the India study was the first to research this outside the US. The study was funded by the National Institute of Mental Health, part of the US National Institutes of Health (NIH). Results from the study are to be published in the Journal of the American Medical Association (JAMA) on Tuesday.

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 being treated at four different diabetes clinics (one government and three private) in India for over two years.

A simple set of tools were given to caregivers and counsellors at the diabetes clinics to identify people with depression and intervene, said Dr Mohan. It was found in a year that their mild and moderate depressive symptoms had improved and so had other indicators on blood sugar and cholesterol, he said.

The integrated approach also helps, as there is a shortage of psychiatrists in the country. During Covid-19 lockdowns, counselling at the diabetes clinics can help catch patients who may otherwise fall through the cracks of a fragmented approach in healthcare, he says, adding that individuals who may have needed a psychiatrist’s intervention were referred to one.

Researchers from Chennai’s MDRF, Atlanta’s Emory University and University of Washington (Seattle), Delhi’s All India Institute of Medical Sciences (AIIMS), Bangalore’s Diacon Hospital and Visakhapatnam’s Endocrine and Diabetes Centre collaborated on the study.

“Too often, mental health is overlooked due to fragmented care, the stigma of psychiatric illnesses, and shortages of mental health professions,” said first author Mohammed Ali, in a statement. Dr Ali is vice-chair of family and preventive medicine at Emory University. Depression worsens patients’ likelihood of managing their diabetes well, resulting in a higher risk of heart attacks and other diabetes complications and mortality, he added.

Other researchers in the study included AIIMS’ Nikhil Tandon, Co-Principal Investigator, Dr S.R. Aravind, Diacon Hospital and Dr GR Sridhar, Endocrine and Diabetes Centre. MDRF’s Dr S Poongothai was the National Coordinator of the study.

Published on August 18, 2020

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