Collaborative care model improves depressive symptoms and cardiovascular health for people with diabetes, JAMA study shows

August 17, 2020

By Catherine Morrow

A low-cost one-year integrated or "collaborative" care model delivered in diabetes clinics can lower depressive symptoms and improve cardiometabolic health, researchers from Emory University, University of Washington, and collaborators in India have found. The results of the study were recently published in JAMA.

In the INDEPENDENT (Integrating Depression and Diabetes Treatment) study, funded by the National Institute of Mental Health (R01MH100390-01), researchers compared an integrated collaborative care model with usual care in 404 patients with diabetes and moderate-to-severe depressive symptoms attending four diverse diabetes clinics in India over a two-year period and found major improvements in the group receiving the integrated approach.

Mohammed K. Ali, MD, principal investigator, associate professor of global health and epidemiology at the Rollins School of Public Health, and Vice Chair of Family and Preventive Medicine at Emory University, is first author of the paper.

“People with diabetes have a higher risk than people without diabetes of experiencing depression, which worsens their likelihood of managing their diabetes well, resulting in higher risk of heart attacks and other diabetes complications and mortality,” says Ali.

“Too often, mental health is overlooked due to fragmented care, stigma of psychiatric illnesses, and shortages of mental health professions. Fragmentation is common but is especially pronounced in low- and middle-income countries like India or in under-resourced and under-served settings in the United States.”

Researchers note that improvements were more pronounced in patients with the worst parameters at the start of the study, and improvements in cardiometabolic parameters waned after the active one-year period, suggesting the need for continued support for blood sugar, blood pressure and cholesterol levels. 

Viswanathan Mohan, MD, PhD, chairman of Dr. Mohan’s Diabetes Specialties Centre and director of Madras Diabetes Research Foundation, is senior author of the study.

“This was the first study reporting on whether a one-year integrated, collaborative care model has sustainable effects at 2 years,” says Mohan. “Due to the shortage of psychiatrists in India, we used care coordinators who were specially trained to screen and provide counseling for depression. This low-cost model produced impressive results both in improving depression as well as in several metabolic parameters and can be useful in other settings and countries.”

Contributing authors included K.M. Venkat Narayan, MD, and Shivani Patel, PhD, from Emory University and Lydia Chwastiak, MD, from the University of Washington School of Medicine.