Added November 26, 2018

Providing a high level of quality care by addressing the whole patient is central to improving the cost of care today and in the years to come. For this reason, healthcare professionals and researchers have focused on uncovering the factors which contribute a community’s high-risk patient population.  For example, researchers have been able to identify that major depression is a common problem among people with both type 1 and type 2 Diabetes.

As continuing research delves deeper into connecting the link, chronic care management teams must acknowledge that this problem is more than a patient feeling intermittent sadness related to their diabetes. Clinical and chronic depression is a long-lasting, debilitating disorder that interrupts a patient’s daily life and relationships. Depression can be so deeply interconnected with diabetes that researchers now believe it is a two-way relationship.

In the article, The Diabetes and Depression Connection it states: “People with diabetes are more likely to develop depression, and people with depression are more likely to develop diabetes.”

Depression and diabetes are a particularly difficult combination because each condition reinforces the other. When diabetes and depression go together, it contributes to greater functional disability and early mortality,” reports Mary de Groot, PhD, acting director of the Diabetes Translational Research Center at Indiana University. (1)

These two conditions truly create a vicious cycle: diabetes aggravates the symptoms of depression, and depression makes it increasingly difficult to effectively manage diabetes. Dr. Poretsky, a specialist in diabetes relates, “If control of diabetes is deteriorating, look for depression as a possible cause of this deterioration.” (2)

Women Have a Higher Prevalence of Diabetes and Depression

An observational study in the Netherlands analyzed twenty years of patient data and concluded that women are approximately twice as likely as men to suffer from depression as a comorbid disease, particularly if they have diabetes. Additionally, this study showed an increased age and low socioeconomic status are associated with an increased number of patients with comorbid diseases. The prevalence of chronic diseases doubled between 1985 and 2005, and the proportion of patients with four or more chronic diseases increased in this period by approximately 300%. (3)

To further complicate the problem, medications used by women to treat depression can increase the risk of developing diabetes. Hormonal contraceptives specific for women have been linked to a rise in depression, obesity, and diabetes. This is not an easy problem to address. (4)

In addition, previous studies have shown individuals who are insulin-resistant may have higher serotonin concentrations and may be more prone to depression and even suicide. (5)

“Depression is not only common in persons with diabetes but contributes to not taking medicines, not following prescribed diets, and overall reduced quality of life,” said lead researcher Dr. Hillary R. Bogner, Assistant Professor at the Department of Family Practice and Community Medicine at the University of Pennsylvania. (6)

Whole Patient Care Prolongs Life For Older Adults with Depression and Diabetes

According to a CDC report from 2017, Diabetes affects over 30 million adults in the United States and diabetes affects older adults at a greater incidence, afflicting about 25% of people over 65 years old. In addition, 68% for adults over the age of 65 have two or more comorbid chronic conditions like depression. (7)

Depression is also highly prevalent in older adults with diabetes. Up to 30% of individuals with diabetes have a significant number of depressive symptoms and 12 to 18% meet the diagnostic criteria for major depression. When depression is factored into the equation, the comorbidity of the two diseases leads to increased medical expenses and can even cause early death. (8)

Primary Care Innovation for Depression Management

One of the best care settings to treat depression is within primary care. Primary care teams have access to patients that other care settings don’t provide. It is within primary care a patient would typically be getting their diabetes treated. It only makes sense that getting support for patients’ other comorbid conditions like depression within the same setting by the same team would produce the best patient outcome.

A psychiatric collaborative model was tested by a group of primary care patients in New York City, Philadelphia, and Pittsburgh. They focused on treating diabetic patients who also had depression. During a five-year period, they monitored patients with this comorbid approach and proved that treating depression reduced mortality more for those who had diabetes than for those who did not. (9)

Multimorbidity places a heavy weight on healthcare organizations and professionals, requiring a significant amount of time and cost. Now, more than ever, to improve the quality of care and positively affect the cost of care, healthcare organizations must work together to reduce the burden of long-lasting, highly involved chronic diseases like diabetes and depression, especially within primary care.

Improving Patient Outcomes Through Technology-Based Care Management

The increasing amount of chronic disease prevalence, as well as multimorbidity, in primary care, has created a need for improved medical care. This is especially applicable in the case of comorbidity between depression and diabetes.

There are several treatment options for managing depression and diabetes which can be elevated with care management technology:

• Diabetes self-management programs. Behavior-based management programs have helped patients to self-manage their condition through diet, exercise, blood sugar control, weight loss, and management of cardiovascular disease risk factors. These programs can help a patient improve satisfaction and quality of life.
• Patients who are treated with psychotherapy, especially cognitive behavioral therapy, demonstrate improvement in their depression symptoms, which helps them better manage their diabetes.
• Medications and lifestyle changes. Medications for both conditions can improve outcomes for patients. Additionally, lifestyle changes can improve symptoms and help patients further manage their conditions.
• Collaborative Care Managers. Nurse case managers can provide the support that patients need, by stepping in when the patient is struggling. However, this care is not always available in health care systems, often due to understaffing. (10)

As the rate of chronic and comorbid diseases continues to rise, primary care doctors will become even more burdened with time-consuming patients requiring complex care. This is further exacerbated by the lack of physician bandwidth prevalent in most physician practices.

CareAdopt recognizes that a gap has been created between the healthcare needs of patients and the realistic abilities of physicians and other providers. We believe this gap can be reduced through a patient-centered approach utilizing an improved chronic care management integration system which takes advantage of technology and personal and professional care managers.

CareAdopt’s results in fewer adverse events, higher patient satisfaction, and lower rehospitalization rates. Care coordination through CareAdopt facilitates increased reimbursements and improved quality of care for health organizations throughout the country.

REFERENCES

• http://www.diabetesforecast.org/2018/03-may-jun/the-diabetes-and-depression.html
• https://www.webmd.com/depression/news/20101122/new-links-seen-between-depression-and-diabetes#2
• https://www.ncbi.nlm.nih.gov/pubmed/18949641
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4847053/#B1-ijerph-13-00391
• https://www.nimh.nih.gov/health/publications/depression-in-women/index.shtml
• https://www.theguardian.com/commentisfree/2016/oct/03/pill-linked-depression-doctors-hormonal-contraceptives
• http://www.diabetes.org/newsroom/press-releases/2007/treating-depression-prolongs-life-112707.html
• https://www.cdc.gov/diabetes/pdfs/data/statistics/national-diabetes-statistics-report.pdf
• https://www.ncbi.nlm.nih.gov/pubmed/17054590
• https://www.mayoclinic.org/diseases-conditions/diabetes/expert-answers/diabetes-and-depression/faq-20057904