Collaborative care for patients with depression and diabetes mellitus: a systematic review and meta-analysis

Abstract

BackgroundDiabetic patients with depression are often inadequately treated within primary care. These comorbid conditions are associated with poor outcomes. The aim of this systematic review was to examine whether collaborative care can improve depression and diabetes outcomes in patients with both depression and diabetes.MethodsMedline, Embase, Cochrane library and PsyINFO were systematically searched to identify relevant publications. All randomized controlled trials of collaborative care for diabetic patients with depression of all ages who were reported by depression treatment response, depression remission, hemoglobin A1c (HbA1c) values, adherence to antidepressant medication and/or oral hypoglycemic agent were included. Two authors independently screened search results and extracted data from eligible studies. Dichotomous and continuous measures of outcomes were combined using risk ratios (RRs) and mean differences (MDs) with 95% confidence intervals (CIs) either by fixed or random-effects models.ResultsEight studies containing 2,238 patients met the inclusion criteria. Collaborative care showed a significant improvement in depression treatment response (RR = 1.33, 95% CI = 1.05-1.68), depression remission (adjusted RR = 1.53, 95% CI =1.11-2.12), higher rates of adherence to antidepressant medication (RR = 1.79, 95% CI = 1.19-2.69) and oral hypoglycemic agent (RR = 2.18, 95% CI = 1.61-2.96), but indicated a non-significant reduction in HbA1c values (MD = -0.13, 95% CI = -0.46-0.19).ConclusionsImproving depression care in diabetic patients is very necessary and important. Comparing with usual care, collaborative care was associated with significantly better depressive outcomes and adherence in patients with depression and diabetes. These findings emphasize the implications for collaborative care of diabetic patients with depression in the future.

Relationship between depression and diabetes in pregnancy: A systematic review

“…Given the expected increase in the number of women with DIP and depression, together with the particular challenges these women face in caring for themselves and their children, healthcare professionals need more specific guidance on management strategies for these patients. A collaborative care approach involving primary care physicians and specialists improves outcomes in non-pregnant patients with both diabetes and depression[78], and a similar model may be effective for the management of pregnant and postpartum women. Such guidance, however, should be based on sound research evidence, which, as our review demonstrates, is currently lacking.…”

Collaborative Care: Models for Treatment of Patients with Complex Medical-Psychiatric Conditions

“…Adopting a collaborative approach led to better depression outcomes and improved adherence to treatment for depression and diabetes, suggesting that there is a need to focus on collaborative care that emphasises improvement of the concurrent management of both conditions [20••].…”

Anxiety and diabetes: Innovative approaches to management in primary care

“…[82][83][84][85][86][87] These models involve routine depression screening among individuals with uncontrolled diabetes, on-site care managers providing between-visit phone calls to assess diabetes self-care adherence, and on-site behavioral health providing brief interventions and SMG during the clinic visit. CCMs of diabetes and depression yield improvements in depression-related outcomes, [87][88][89][90][91] increased adherence to diabetes and depression self-management, 92,93 and decreased rates of mortality, compared to usual care. 94 Limited quantitative data are available supporting the association of collaborative care with improvement in HbA1c; however, one study showed that the incorporation of health coaching into diabetes management was associated with accelerated HbA1c reduction and improved mood as measured by Hospital Anxiety and Depression Scale (HADS).…”