SUMMARIES FOR PATIENTS

Depression Care Management for Older Adults with both Depression and Diabetes

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The summary below is from the full report titled "The Effectiveness of Depression Care Management on Diabetes-Related Outcomes in Older Patients." It is in the 15 June 2004 issue of Annals of Internal Medicine (volume 140, pages 1015-1024). The authors are J.W. Williams Jr., W. Katon, E.H.B. Lin, P.H. Nöel, J. Worchel, J. Cornell, L. Harpole, B.A. Fultz, E. Hunkeler, V.S. Mika, and J. Unützer.

What is the problem and what is known about it so far?

Many older people have both depression and diabetes. Depression is a medical condition causing sadness that interferes with daily life. About 1 of every 5 people has depression at some time in their life, and depression is very common among older people. Sometimes, depression goes away on its own, but many depressed people need treatment with counseling or medication to speed recovery. Diabetes mellitus is a common disease that interferes with the body's ability to store energy from food. Diabetes leads to high levels of blood sugar that, over time, can cause complications that include blindness, kidney failure, nerve damage, and cardiovascular disease (heart attacks and strokes). Fortunately, keeping blood sugar, blood pressure, and cholesterol levels under control can reduce the chances of these complications. Diabetes care requires that a person follows a careful diet, exercises regularly, checks blood sugar levels, and takes diabetes medicines as prescribed. Some worry that when a person has both depression and diabetes, depression can interfere with diabetes care.

Why did the researchers do this particular study?

To determine whether treating depression in people who had both depression and diabetes improves diabetes care and outcomes.

Who was studied?

417 patients who were 60 years of age or older and who had both diabetes and depression.

How was the study done?

The researchers assigned patients to usual care or to a depression care management program. Patients in the depression care management program were assigned a care manager—a person who offered patient education, helped with depression medications and treatment, and helped coordinate primary and specialty care. The care manager focused on depression care and did not intervene specifically with diabetes care. The researchers collected information about depression and diabetes outcomes at the start of the study and after 3, 6, and 12 months. For 293 study patients, the researchers also collected blood samples to test for hemoglobin A_1c levels. Hemoglobin A_1c levels reveal how well a person's diabetes is controlled over recent months.

What did the researchers find?

Depression care management for depressed patients with diabetes improved depression-related outcomes and the frequency of exercise. However, depression care management did not affect how well patients followed their diabetes diet, whether patients took their diabetes medications as prescribed, or how often patients tested their blood sugar level. In addition, it did not affect hemoglobin A_1c levels.

What were the limitations of the study?

Study patients had reasonably good diabetes control at the start of the study. The study cannot rule out an effect of depression care on diabetes outcomes for patients with poorly controlled diabetes.

What are the implications of the study?

Among older patients with both depression and diabetes, depression care management improves depression and increases the frequency of exercise but has no effect on diabetes-related outcomes.