Can the management of depression in type 2 diabetes be democratized?

Abstract

Both type 2 diabetes and depression are common and are projected to increase. There is increasing evidence for a bidirectional relationship between the two. Diabetes is a risk factor for depression; contrariwise, individuals with depression are at greater risk of developing diabetes. They are a burden for both the individual and the society. Co-existent depression worsens diabetic control because of obesity, insulin resistance and the adverse metabolic effects of anti-diabetes medicines. In addition, compliance to lifestyle measures required for diabetes is also compromised such as following a specific diet, taking proper medications on time, getting metabolic parameters assessed and maintaining a sleep cycle. Depression occurs in many grades; mild depression is more common in diabetes than frank or full-blown depression leading to suicide. Unfortunately, there are not enough trained and accessible mental health professionals such as psychologists or psychiatrists to deal with the increasing burden of depression in diabetes. Therefore, alternate models for management of mild to moderate depression are required. There is evidence that a team-approach by employing health care assistants can lower the risk of cardiac risk factors. INtegrating DEPrEssioN and Diabetes treatmENT study was carried out to determine whether the team-approach using non-health care professionals could be effective in managing mild to moderate depression and to study its effects on metabolic parameters among subjects with type 2 diabetes mellitus. The international study, carried out in four independent centers in India assessed the impact of a trained but not qualified non-psychiatrist in coordinating and forming a fulcrum between the patient, the family and the consultant endocrinologist/diabetologist. The interventions were fine-tuned to be culturally appropriate by qualitative interviews before they began. It was shown that the outcomes of both depression and diabetes could be improved by the employment of a clinical care coordinator. It is possible to scale up the studies to wider geographical areas and health-care organizations.

Keywords: Insulin resistance; Bidirectional; Patient health questionnaire-9; Care-coordinator; Antidepressants; Integrating DEPrEssioN and Diabetes treatmENT study; Non-professional

Core Tip: Type 2 diabetes and depression frequently co-exist. The presence of one worsens the outcome of the other. There are insufficient qualified professionals to treat depression. The INtegrating DEPrEssioN and Diabetes treatmENT study has shown that care-coordinators, who are trained but not professionals in mental health care can integrate and liaison among the patient, the family and specialists in treating mild to moderate depression associated with diabetes. Deployment of care-coordinators improved the outcome of depression and diabetes. This proof-of-concept study can be expanded and if found useful, help in democratizing the management of depression in diabetes.