Today, our cousin the Mental Elf has posted an important blog about the management of people with diabetes and depression.
Around 20% of patients with diabetes meet diagnostic criteria for depression. NICE guidelines state that Collaborative Care (CC) should form part of a well-developed stepped-care programme for people with moderate to severe depression and a long-term condition.
CC requires joint working between the patient and healthcare professional to identify problems and agree goals for interventions. Furthermore CC must comprise:
- Case management (supported by a senior mental health professional),
- Multi-professional collaboration (between primary and secondary physical health services and specialist mental health),
- A range of evidence-based interventions,
- And long term coordination of care and follow-up.
A new systematic review, nicely summarised by Amy Green on The Mental Elf, looked at the RCT evidence on the effects of CC compared with standard models of care.
Eight RCTs were included in the analysis. The results found some evidence of benefit for depression outcomes, with better response to treatment and adherence to medication.
For diabetes outcomes, the results were less clear. Whilst there was some evidence of improved adherence to medications, the review did not find a signficant improvement in glycaemic control.
This review shows that Collaborative Care may indeed improve outcomes for patients with depression and diabetes. However, the results are not all that dramatic and further research is warranted to investigate the durability of benefits. In particular, we should be cautious about improvements in glycaemic control, as the review did not find a significant benefit in this area. This could be due to short study duration, small sample size or indeed the nature of the study population included.
We’ll head on over to the Mental Elf and join the chat there.