The Effectiveness of Depression Care Management on Diabetes-Related Outcomes in Older Patients.
Williams, John W. Jr. MD, MHSc; Katon, Wayne MD; Lin, Elizabeth H.B. MD; Noel, Polly H. PhD; Worchel, Jason MD; Cornell, John PhD; Harpole, Linda MD, MPH; Fultz, Bridget A. MA; Hunkeler, Enid MA; Mika, Virginia S. MPH; Unutzer, Jurgen MD; the IMPACT Investigators *
[Miscellaneous Article]
Annals of Internal Medicine.
140(12):1015-1024, June 15, 2004.
(Format: HTML, PDF)
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 A1c 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.
(C) 2004 American College of Physicians