Collaborative Care for Depression and Diabetes

Studies have shown that diabetes is a chronic physical health condition often linked with symptoms of depression. Comorbid depression and diabetes can significantly worsen patient self-care, health, and economic burden of diabetes. The National Institute for Health and Care Excellence’s current guidelines for depression in adults with chronic physical health problem recommend collaborative care in order to organize patient health services.

A recent study’s findings suggest that collaborative care for depression significantly improves both depression and glycemic outcomes in individuals with comorbid depression and diabetes. [BMJ Open. 2014;4:e004706].

The systematic meta-analysis used PubMed, Scopus, Cochrane Library, CINAHL, Health Source Nursing, MEDLINE, PsychINFO, and reference lists of retrieved articles published prior to August 2013. Articles including randomized, controlled trials on collaborative care for depression reporting on both depression and glycemic outcomes in adults were eligible for study review.

The study’s primary outcome was the mean difference in depression and glycated hemoglobin (HbA1c) outcomes between treatment and control groups.

A total of 7 randomized, controlled trials were included in the review; all studies were published between 2004 and 2013, and all but 1 study were conducted in the United States. The patient sample size in these 7 studies ranged from 58 to 417 participants, resulting in a total of 1895 participants for depression outcomes and 1556 participants for HbA1c outcomes.  

Collaborative care models included in the studies were defined as a case manager/officer with proactive follow-ups, a structured management plan delivered within a stepped care framework and relapse prevention, an integrated diabetes care program, and consideration for lifestyle risk factors. Of the studies included, the trial durations ranged from 12 to 52 weeks.

In terms of the findings on the effect of collaborative care on depression, depression outcomes were significantly improved compared to the control conditions (pooled standardized mean difference [SMD], -0.32; 95% confidence interval [CI], -0.53–-0.11). With regard to effect of collaborative care on HbA1c level, collaborative care significantly reduced the HbA1c level compared with control conditions (pooled weighted mean difference [WMD], -.033%; 95% CI, -0.66-0).

The results of a meta-regression model found the SMD in depression scores failed to predict the WMD in HbA1c values across studies (95% CI, -1.93-2.31; P=.828).

Overall, the researchers determined that the study’s results suggests collaborative care for depression significantly improves depression and glycemic outcomes in individuals with comorbid depression and diabetes.

Limitations of the study include that only a small number of short- to medium-term studies predominantly conducted in the United States were included. Thus, these findings may not be relevant to healthcare settings in other countries.

The study’s authors noted that additional research in this area is needed. Future research should examine the effectiveness, feasibility, and appropriateness of collaborative care through routine clinical practice in specific healthcare settings worldwide.