Depression Care Management for Older Adults with both Depression and Diabetes. Ann Intern Med. 2004;140:(12):I-48. doi: 10.7326/0003-4819-140-12-200406150-00005
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Published: Ann Intern Med. 2004;140(12):I-48.
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.
To determine whether treating depression in people who had both depression and diabetes improves diabetes care and outcomes.
417 patients who were 60 years of age or older and who had both diabetes and depression.
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 A1c levels. Hemoglobin A1c levels reveal how well a person's diabetes is controlled over recent months.
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 A1c levels.
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.
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.
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Cardiology, Endocrine and Metabolism, Geriatric Medicine, Diabetes, Coronary Risk Factors.
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