Format

Send to:

Choose Destination
See comment in PubMed Commons below
Ann Intern Med. 2004 Jun 15;140(12):1015-24.

The effectiveness of depression care management on diabetes-related outcomes in older patients.

Author information

  • 1Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, and Duke University School of Medicine, Durham, North Carolina 27705, USA.

Abstract

BACKGROUND:

Depression frequently occurs in combination with diabetes mellitus, adversely affecting the course of illness.

OBJECTIVE:

To determine whether enhancing care for depression improves affective and diabetic outcomes in older adults with diabetes and depression.

DESIGN:

Preplanned subgroup analysis of the Improving Mood-Promoting Access to Collaborative Treatment (IMPACT) randomized, controlled trial.

SETTING:

18 primary care clinics from 8 health care organizations in 5 states.

PATIENTS:

1801 patients 60 years of age or older with depression; 417 had coexisting diabetes mellitus.

INTERVENTION:

A care manager offered education, problem-solving treatment, or support for antidepressant management by the patient's primary care physician; diabetes care was not specifically enhanced.

MEASUREMENTS:

Assessments at baseline and at 3, 6, and 12 months for depression, functional impairment, and diabetes self-care behaviors. Hemoglobin A(1c) levels were obtained for 293 patients at baseline and at 6 and 12 months.

RESULTS:

At 12 months, diabetic patients who were assigned to intervention had less severe depression (range, 0 to 4 on a checklist of 20 depression items; between-group difference, -0.43 [95% CI, -0.57 to -0.29]; P < 0.001) and greater improvement in overall functioning (range, 0 [none] to 10 [unable to perform activities]; between-group difference, -0.89 [CI, -1.46 to -0.32]) than did participants who received usual care. In the intervention group, weekly exercise days increased (between-group difference, 0.50 day [CI, 0.12 to 0.89 day]; P = 0.001); other self-care behaviors were not affected. At baseline, mean (+/-SD) hemoglobin A1c levels were 7.28% +/- 1.43%; follow-up values were unaffected by the intervention (P > 0.2).

LIMITATIONS:

Because patients had good glycemic control at baseline, power to detect small but clinically important improvements in glycemic control was limited.

CONCLUSIONS:

Collaborative care improves affective and functional status in older patients with depression and diabetes; however, among patients with good glycemic control, such care minimally affects diabetes-specific outcomes.

PMID:
15197019
[PubMed - indexed for MEDLINE]
PubMed Commons home

PubMed Commons

0 comments
How to join PubMed Commons

    Supplemental Content

    Full text links

    Icon for Silverchair Information Systems
    Loading ...
    Write to the Help Desk