John W. Williams, MD, MHSc; Wayne Katon, MD; Elizabeth H.B. Lin, MD; Polly H. Nöel, PhD; Jason Worchel, MD; John Cornell, PhD; Linda Harpole, MD, MPH; Bridget A. Fultz, MA; Enid Hunkeler, MA; Virginia S. Mika, MPH; Jürgen Unützer, MD; the IMPACT Investigators*
Disclaimer: The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs.
Acknowledgments: The authors thank the contributions of the IMPACT study advisory board (Lydia Lewis; Lisa Goodale, ACSW; Howard Goldman, MD, PhD; Thomas Oxman, MD; Lisa Rubenstein, MD, MSPH; Cathy Sherbourne, PhD; Kenneth Wells, MD, MPH); statistical consultation from Lingqi Tang, PhD; and outstanding programming support by Tonya Marmon, MS. The authors also acknowledge the contributions and support of patients, providers, and staff and the use of resources and facilities at the study coordinating center and at all participating study sites.
Grant Support: By grants from the Robert Wood Johnson Foundation, the John A. Hartford Foundation, the California Healthcare Foundation, and the Hogg Foundation.
Potential Financial Conflicts of Interest:Consultancies: J.W. Williams Jr. (GlaxoSmithKline, Pfizer), E.H.B. Lin (Pfizer, Wyeth); Honoraria: J.S. Williams Jr. (Pfizer, Wyeth-Ayerst), E.H.B. Lin (Pfizer, Wyeth); Grants received: J.W. Williams Jr. (Eli Lilly, Pfizer), E.M. Hunkeler (Eli Lilly, Merck & Co., Solvay).
Requests for Single Reprints: John W. Williams, MD, MHSc, Durham Veterans Affairs Medical Center (152), Center for Health Services Research in Primary Care, 508 Fulton Street, Durham, NC 27705.
Current Author Addresses: Dr. Williams: Center for Health Services Research in Primary Care, HSR&D (Building 6), 508 Fulton Street, Durham, NC 27705.
Drs. Katon and Unützer: Department of Psychiatry, University of Washington, Box 356560, 1959 NE Pacific, Seattle, WA 98195.
Dr. Lin: Center for Health Studies, Group Health Cooperative, 1730 Minor Avenue #1600, Seattle, WA 98101.
Drs. Nöel and Cornell: South Texas Veterans Health Care System, 7400 Merton Minter Boulevard, San Antonio, TX 78229.
Dr. Worchel: Central Texas Veterans Health Care System, 2901 Montopolis, Austin, TX 78741.
Dr. Harpole: Duke University Medical Center, 3024 Pickett Road, Durham, NC 27705.
Ms. Fultz: Regenstrief Institute, Inc., 1050 Wishard Boulevard, RG 6, Indianapolis, IN 46202.
Ms. Hunkeler: Division of Research, Kaiser Permanente–Northern California, 3505 Broadway, 7th Floor, Oakland, CA 94611.
Ms. Mika: University of Texas Health Science Center, 7703 Floyd Curl Drive, San Antonio, TX 78229.
Williams J., Katon W., Lin E., Nöel P., Worchel J., Cornell J., Harpole L., Fultz B., Hunkeler E., Mika V., Unützer J., ; The Effectiveness of Depression Care Management on Diabetes-Related Outcomes in Older Patients. Ann Intern Med. 2004;140:1015-1024. doi: 10.7326/0003-4819-140-12-200406150-00012
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Published: Ann Intern Med. 2004;140(12):1015-1024.
Many patients have both diabetes and depression. Some hypothesize that treating depression might improve diabetes outcomes.
In this randomized trial, 12 months of depression care management for depressed patients with diabetes improved depression-related outcomes and increased the frequency of exercise. However, care management did not affect diet, diabetes medication adherence, glucose testing, or glycemic control.
The study sample had reasonably good diabetes control at baseline. Whether patients with poorly controlled diabetes would benefit from depression care is not known.
Major depression and dysthymic disorder affect 5% to 10% of older adults seen in primary care settings (1-3). Late-life depression is often chronic or recurrent (4-6) and is associated with substantial suffering, functional impairment, and diminished health-related quality of life (7). Diabetes mellitus affects 7.8% of all adults and almost 1 in 5 of those age 60 years and older (8). Individuals with diabetes mellitus have a 2-fold higher rate of major depression than those without diabetes (9, 10).
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Cardiology, Endocrine and Metabolism, Geriatric Medicine, Diabetes, Coronary Risk Factors.
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