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The effectiveness of depression care management on diabetes-related outcomes in older patients.

Publication ,  Journal Article
Williams, JW; Katon, W; Lin, EHB; Nöel, PH; Worchel, J; Cornell, J; Harpole, L; Fultz, BA; Hunkeler, E; Mika, VS; Unützer, J; IMPACT Investigators,
Published in: Ann Intern Med
June 15, 2004

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 A(1c) 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.

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Published In

Ann Intern Med

DOI

EISSN

1539-3704

Publication Date

June 15, 2004

Volume

140

Issue

12

Start / End Page

1015 / 1024

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Self Care
  • Psychotherapy
  • Patient Compliance
  • Male
  • Humans
  • Health Behavior
  • Glycated Hemoglobin
  • General & Internal Medicine
  • Female
 

Citation

APA
Chicago
ICMJE
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Williams, J. W., Katon, W., Lin, E. H. B., Nöel, P. H., Worchel, J., Cornell, J., … IMPACT Investigators, . (2004). The effectiveness of depression care management on diabetes-related outcomes in older patients. Ann Intern Med, 140(12), 1015–1024. https://doi.org/10.7326/0003-4819-140-12-200406150-00012
Williams, John W., Wayne Katon, Elizabeth H. B. Lin, Polly H. Nöel, Jason Worchel, John Cornell, Linda Harpole, et al. “The effectiveness of depression care management on diabetes-related outcomes in older patients.Ann Intern Med 140, no. 12 (June 15, 2004): 1015–24. https://doi.org/10.7326/0003-4819-140-12-200406150-00012.
Williams JW, Katon W, Lin EHB, Nöel PH, Worchel J, Cornell J, et al. The effectiveness of depression care management on diabetes-related outcomes in older patients. Ann Intern Med. 2004 Jun 15;140(12):1015–24.
Williams, John W., et al. “The effectiveness of depression care management on diabetes-related outcomes in older patients.Ann Intern Med, vol. 140, no. 12, June 2004, pp. 1015–24. Pubmed, doi:10.7326/0003-4819-140-12-200406150-00012.
Williams JW, Katon W, Lin EHB, Nöel PH, Worchel J, Cornell J, Harpole L, Fultz BA, Hunkeler E, Mika VS, Unützer J, IMPACT Investigators. The effectiveness of depression care management on diabetes-related outcomes in older patients. Ann Intern Med. 2004 Jun 15;140(12):1015–1024.

Published In

Ann Intern Med

DOI

EISSN

1539-3704

Publication Date

June 15, 2004

Volume

140

Issue

12

Start / End Page

1015 / 1024

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Self Care
  • Psychotherapy
  • Patient Compliance
  • Male
  • Humans
  • Health Behavior
  • Glycated Hemoglobin
  • General & Internal Medicine
  • Female