A low-cost one-year integrated or “collaborative” care model delivered in diabetes clinics can lower depressive symptoms and improve cardiometabolic health, diabetes researchers from India, in collaboration with colleagues from Emory University, Atlanta, and the University of Washington, have found. The results of the study have been published in JAMA.
The study was performed on 400 patients from four centres in Delhi, Chennai, Bengaluru and Vishakapatnam. In the INDEPENDENT (Integrating Depression and Diabetes Treatment) study, funded by the National Institute of Mental Health, researchers compared an integrated collaborative care model with usual care in more than 400 patients with diabetes, with moderate-to-severe depressive symptoms attending four diverse diabetes clinics in India, over a two-year period and found major improvements in the group receiving the integrated approach.
“There is a strong likelihood of developing depression in patients with chronic non-communicable diseases such as diabetes. This has a negative impact on the ability of the patient and their care-givers (medical and family) to manage the disease and also the quality of life, making it imperative to provide integrated care for mental health issues in patients with NCDs,” said Prof Nikhil Tandon, Department of Endocrinology and Metabolism, who led the study at AIIMS, New Delhi. The AIIMS team included Professor Rajesh Sagar, Department of Psychiatry, and Professor Rajesh Khadgawat, Department of Endocrinology and Metabolism.
This study used an innovative strategy, wherein non-physician health care providers help coordinate care between the diabetes management team and mental health professionals, leveraging technology.
Researchers note that improvements were more pronounced in patients with the worst parameters at the start of the study. The results also report that observed benefits wane on discontinuing the intervention, implying the need for continued support.
Dr Mohammed Ali, principal investigator at the Rollins School of Public Health, said “Too often, mental health is overlooked due to fragmented care, the stigma of psychiatric illnesses, and shortage of mental health professionals. Fragmentation is common but is especially pronounced in low- and middle-income countries like India or in under-resourced and under-served settings in the United States.”