Program Helps People With Diabetes Fight Depression

Written by Thomas G. Ciccone
Reviewed by Eliot LeBow, LCSW, CDE

Depression is a serious problem, one that people with diabetes are all too to familiar with. Depression can make life unmanageable, especially for those living with diabetes. How can treating depression help diabetes? Well, diabetes and depression can go hand-in-hand. Studies continue to find that many people with diabetes can have severe depression, which damages mental and physical health.1

Fortunately, lifestyle interventions and psychological counseling2 can seriously improve a patient's life. Psychotherapy and medication have been proven to work, but nothing will work if you don't take the first step. Speak with your doctor, or reach out to a local organization. 

Pilot Study

Treating depression isn't just about improving mental outlook, it fosters better control of blood sugar levels, which improves health. In a recent pilot study, doctors at FirstHealth, a health care center in North Carolina, found significant success treating depression in their patients. Sure enough, they discovered that as patients' depression decreased, so did blood sugar levels (blood glucose A1c).

The patients in the program live in a rural, central area of the state, where low incomes are all too common. For instance, more than a fifth of the population subsists below the Federal Poverty Level. A low income mounts even more challenges against a patient with diabetes, making the risk of developing depression more likely.

In 2007, FirstHealth surveyed the area for the prevalence for diabetes and found that 15.6% of the population had diabetes—noticeably higher than the state's average (9.1%). This was the impetus behind the creation of FirstHealth's Diabetes and Depression Project.

During the study, a total of 182 patients with Type 2 diabetes were screened for depression and then treated by a mental health coach. When a patient scored positive for depressive symptoms, a social worker made multiple visits to give them advice and counseling about their illness and how to deal with their diabetes, depression, and the stressors in their lives. Patients received 3 of these therapy sessions on average.

Follow-up treatments were also made available to patients and encouraged, according to Melissa Herman, RD, the program director of the Diabetes & Nutrition Education Center for FirstHealth of the Carolinas, in Pinehurst.

"As diabetes educators, we recognize how critical follow-up support is for patients living with chronic disease, particularly a disease as complex and dynamic as diabetes," Dr. Herman told DiabeticLifestyle. "If patients were actively engaged and demonstrated that they were benefiting from the sessions, the diabetes educator and behavioral coach would continue to work with them indefinitely."

They also worked to help the patients set goals and build techniques for managing the stresses and negative feelings of living with diabetes. This may have made the program atypical, but the results spoke for themselves, she said.

"Imbedding a behavioral health coach is an approach that extends well beyond traditional diabetes self-management education and a resource that is not available in most DSME programs. The coaching sessions paid particular attention to the patients' concerns and worked on a wide range of barriers to care both directly and indirectly tied to diabetes management."

Program Results

After 3 months, the researchers were able to see patients' depression scores cut in half. In addition, blood sugar levels dropped noticeably—A1C levels decreased on average from 8.8% to 7.7%.

The results were presented at the 2014 American Association of Diabetes Educators Annual Meeting & Exhibition, held in Orlando, Florida.

The program was meant to last just 2 years, but is running indefinitely due to its success. Today, patients with diabetes are able to get the help they need to manage their depression.

"If there is anything to learn from this experience, it is that patients want help, don't know how to talk about depression, or where to seek help. Diabetes educators can and should serve in this role as part of a comprehensive treatment approach," Dr. Herman said.

Doctors' Reactions

The link between diabetes and depression is a significant issue,4 so the success of this therapy program has been lauded by other experts and health care providers.

"I think it is a wonderful program, and has the ability to make a huge difference in managing patients with diabetes," said Ronny Bell, PhD, chair of the North Carolina Diabetes Advisory Council (DAC) in Raleigh, North Carolina.

A program for treating depression in people with diabetes could be especially important for patients with low-incomes, where much of the original patient group came from.

"We know that both depression and diabetes are more common in populations with limited economic resources, so it makes sense that the 2 together would be more common and would be a serious problem," said Dr. Bell.

"Given that diabetes requires a significant amount of support, resources, and access to quality health care, it makes it more complicated for limited-resourced individuals to feel successful in managing their condition," he added.

Ivan Perry, MD, PhD, a professor of Epidemiology & Public Health at the University College Cork, in Cork, Ireland, has conducted his own research on depression in diabetics and commented on the relevancy of finding ways to treat it.

"It seems to me self-evident that the development of effective and relevant treatment [programs] for depression in this setting is an extremely important practical issue," Dr. Perry said.

Gary Wittert, MD, Head of Discipline of Medicine at the University of Adelaide, in Adelaide, Australia, called Dr. Herman's work a "tremendous study" and a "clear message for health care practitioners" to be aware of the dangers facing people with diabetes and depression.

Looking Ahead

The program's success has even lead to the implementation of a depression screening tool throughout FirstHealth's community screening programs and clinics, cementing the importance of finding and treating depression in patients with diabetes. However, there are still challenges to treating the depression, Dr. Herman said, such as coordinating with patients' primary care providers when necessary.

For instance, many of the patients that came into the program had already been taking prescribed antidepressants for their depression. After the program, the behavioral health coaches may have prescribed a change or addition to the patients' medication to better treat the depressive symptoms. Oftentimes though, these recommendations were ignored.

"For whatever reason, (recommendations) were often met with mixed results by providers and may be due to the fact that providers are not as familiar with diabetes educators screening for and addressing depression."

FirstHealth's program showed that treating diabetes requires patients to work closely with educators and therapists, so they can recognize why they feel the way they do and can learn how to move forward in their daily lives.

"Close collaboration with the diabetes educator, additional training for the diabetes educators, and having a behavioral health coach with experience in diabetes was critical to the success of the sessions and was key in aiding patients to not only understand what they needed to do but provided an opportunity to develop a detailed map of how to do it."

Dr. Herman coauthored this project with Roxanne Elliott, MS. The program was originally funded through a 2-year grant project awarded by the Kate B. Reynolds Charitable Trust. This research has not been published. There are no conflicts of interest to report.

 

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Diabetes and Depression: Overview