Integrated management of type 2 diabetes mellitus and depression treatment to improve medication adherence: a randomized controlled trial.
OBJECTIVE
Depression commonly accompanies diabetes, resulting in reduced adherence to medications and increased risk for morbidity and mortality. The objective of this study was to examine whether a simple, brief integrated approach to depression and type 2 diabetes mellitus (type 2 diabetes) treatment improved adherence to oral hypoglycemic agents and antidepressant medications, glycemic control, and depression among primary care patients.


METHODS
We undertook a randomized controlled trial conducted from April 2010 through April 2011 of 180 patients prescribed pharmacotherapy for type 2 diabetes and depression in primary care. Patients were randomly assigned to an integrated care intervention or usual care. Integrated care managers collaborated with physicians to offer education and guideline-based treatment recommendations and to monitor adherence and clinical status. Adherence was assessed using the Medication Event Monitoring System (MEMS). We used glycated hemoglobin (HbA(1c)) assays to measure glycemic control and the 9-item Patient Health Questionnaire (PHQ-9) to assess depression.


RESULTS
Intervention and usual care groups did not differ statistically on baseline measures. Patients who received the intervention were more likely to achieve HbA(1c) levels of less than 7% (intervention 60.9% vs. usual care 35.7%; P < .001) and remission of depression (PHQ-9 score of less than 5: intervention 58.7% vs. usual care 30.7%; P < .001) in comparison with patients in the usual care group at 12 weeks.


CONCLUSIONS
A randomized controlled trial of a simple, brief intervention integrating treatment of type 2 diabetes and depression was successful in improving outcomes in primary care. An integrated approach to depression and type 2 diabetes treatment may facilitate its deployment in real-world practices with competing demands for limited resources.
Department of Family Medicine and Community Health, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA. hillary.bogner@uphs.upenn.edu
Hillary R
HR
Bogner
Knashawn H
KH
Morales
Heather F
HF
de Vries
Anne R
AR
Cappola
D000328:Adult; D000368:Aged; D000928:Antidepressive Agents; D001786:Blood Glucose / Q000032:analysis; D003866:Depressive Disorder / Q000150:complications / Q000188:drug therapy*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy* / Q000523:psychology; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents; D016014:Linear Models; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D010348:Patient Care Team; D015143:Philadelphia; D011320:Primary Health Care / Q000379:methods; D011569:Psychiatric Status Rating Scales; D016896:Treatment Outcome
D000928:Antidepressive Agents; D001786:Blood Glucose; D007004:Hypoglycemic Agents