A Prospective, Non-randomized Feasibility and Preliminary Efficacy Study of a Telemedicine-Enabled Co-management Intervention for Adults With Type 2 Diabetes and Moderate Anxiety and/or Depression

Abstract

Purpose The primary aim of this pilot study was to examine the feasibility of codelivering a mental health intervention with an evidence-based type 2 diabetes (T2DM) boot camp care management program. The preliminary impact of participation on symptom scores for depression and anxiety and A1C was also examined. Methods This was a 12-week, non-randomized pilot intervention conducted with a convenience sample of adults with uncontrolled T2DM and moderate depression and/or anxiety at an urban teaching hospital. Co-management intervention delivery was via in-person and telehealth visits. Participants were assessed at baseline and 90 days. Results Participants (n = 18) were African American, majority female (83%), and age 50.7 ± 13.4 years. Significant improvements in mental health outcomes were demonstrated, as measured by a reduction in Patient Health Questionnaire − 9 scores of 2.4 ± 2.9 ( P = .01) and in Generalized Anxiety Disorder − 7 scores of 2.3 ± 1.9 ( P = .001). The pre-post intervention mean A1C improved by 3.4 ± 2.1 units from 12% ± 1.4% to 8.5% ± 1.7% ( P < .001). Conclusion The data generated in this pilot support the feasibility of delivering a diabetes and mental health co-management intervention using a combination of in-person and telemedicine visits to engage adults with T2DM and coexisting moderate depression and/or anxiety. Further research is warranted.

Technology-Supported Integrated Care Innovations to Support Diabetes and Mental Health Care: Scoping Review

“…The included studies were mostly randomized controlled trials or controlled clinical trials (n=14; Tables 1-3). Other study designs included one-group pre-post studies (n=5) [23,31,32,41,44], systematic or literature reviews (n=3) [22,34,40], mixed methods (n=1) [33], and focus groups (n=1) [21]. h CBT: cognitive behavioral therapy.…”

“…Eight studies had a follow-up outcome measurement beyond the end of the study time point. Of the 20 intervention studies, 12 focused on addressing mental health in people living with diabetes [25,27,[31][32][33]36,38,39,[41][42][43][44] and 8 addressed both diabetes and mental health conditions concurrently [23,24,26,[28][29][30]35,37].…”

“…Seven of the 10 subgroups were covered by included studies (Figure 4). These were telemedicine (n=11), client health records (n=5) [25,28,31,37,42], health care provider communication (n=4) [25,26,42,44], health care provider decision support (n=3) [35,42,44], referral coordination (n=2) [23,42], prescription and medication management (n=2) [23,42], and health worker activity planning and schedule (n=1) [44]. These intervention components were mostly related to the professional integration of the study.…”

“…Several studies identified their purpose as providing web-based self-help and health coaching, and only 2 studies used technology to improve access to health care [29,33]. Specifically, there was evidence of clinical integration (access to diabetes and mental health support); however, only 2 studies described health professional integration across diabetes and mental health care providers [23,42]. This finding highlights the state of integrated care, where clinical integration of diabetes care and mental health support exists but does not quite reach integration of health care professionals at the organization and system level.…”

“…This finding highlights the state of integrated care, where clinical integration of diabetes care and mental health support exists but does not quite reach integration of health care professionals at the organization and system level. To that end, of the 7 studies that comprised diabetes and mental health combined interventions, only 3 included professional integration [23,26,35], suggesting that more work needs to be done to prepare health care professionals and organizations for the delivery of integrated care.…”