Collaborative Care Improves Depression but Not Incident Diabetes
Treatment of depression alone may not reduce the excess risk for diabetes in older adults with depression.
Collaborative care for depression leads to improved outcomes in terms of depressive symptoms, according to a study published in PLoS One. However, the risk for incident diabetes is not mitigated by collaborative care as opposed to normal care.
This study included 119 older adults with depression and no diabetes at baseline, of whom 59 were randomly assigned to collaborative care (IMPACT group) and 60 of whom were assigned to usual care. Participants in this study had a median age of 67.2±6.9 years, and 41% were African American. This was a 9-year follow-up study of the Improving Mood-Promoting Access to Collaborative Treatment trial. Baseline characteristics of participants in both groups were compared using chi-square tests and sample t tests.
At 12 months, participants in the IMPACT group demonstrated improved SCL-20 scores compared with those in normal care (P=.024), suggesting decreased symptoms of depression. Psychotherapy was more common among the IMPACT group (60% vs 17%; P <.001), while antidepressant regimens were more common among normal care (73% vs 57%; P =.064).
In the 9-year follow-up period, incident diabetes occurred in 33% of cases. Diabetes occurred in 37% of the IMPACT group and 28% of the normal care group, a difference that was not found to be significant by either log-rank tests (χ2=0.63; P =.427) nor unadjusted (hazard ratio [HR] 1.29; 95% CI, 0.69-2.43; P =.428) or adjusted (HR 1.18; 95% CI, 0.61-2.29; P =.616) Cox models. This adjusted model revealed only body mass index at baseline to predict diabetes (HR 1.05; 95% CI, 1.00-1.10; P =.027).
The study researchers conclude that “depressed, older primary care patients randomized to collaborative depression care exhibited significantly greater reductions in depressive symptoms than those randomized to usual care. Despite these improvements, collaborative care patients had a similar risk of incident clinical diabetes over nine years as usual care patients, even when alternative definitions of incident diabetes were considered.”
Khambaty T, Callahan CM, Stewart JC. Effect of collaborative depression treatment on risk for diabetes: A 9-year follow-up of the IMPACT randomized controlled trial. PLoS One. 2018;13(8):e0200248.