Health Conditions News

Program Aids Diabetes, Depression Care

by Howard LeWine, M.D.
Harvard Medical School

Treating diabetes and depression in a coordinated way can help to improve both, new research suggests. The study included 180 people with both conditions. They were randomly assigned to receive either usual care or an integrated program of care. People in the second group received extra help. A care manager worked with them to help them keep track of and remember to take their medicines. The care manager also provided education about their conditions and other services to improve care. The program lasted 12 weeks. In the usual-care group, more than 3 out of 10 had improvements in blood sugar and depression symptoms. Among those who got extra care, 6 out of 10 improved. The journal Annals of Family Medicine published the study. HealthDay News wrote about it January 20.

What Is the Doctor's Reaction?

Depression and diabetes are two of the most common chronic (long-lasting) diseases in the United States. And they often occur together. About 25% of people with diabetes are depressed. That's nearly twice the rate among people without diabetes.

The exact reason for the link between diabetes and depression is unknown. It's likely there are multiple reasons. People with diabetes might feel depressed by the diagnosis. They also can feel overwhelmed by the effort it takes to manage this disease. And many experts believe they are connected by a biologic link.

Having both depression and diabetes greatly increases the risk of early death. The main reason is the higher rate of heart attacks and blood vessel diseases in people with both conditions.

People with depression are less likely to keep their blood sugar under good control. Unhealthy behaviors linked to heart disease seem to be especially common in people with both depression and diabetes. They are more likely than others to smoke, eat an unhealthy diet and get little exercise. They also tend not to take their medicines regularly for high blood pressure and high cholesterol. Both of these conditions increase the risk of heart disease risk

Until recently, doctors have focused more on treating the diabetes. They have given less attention to the depression. Why?

• Past studies have suggested that depression does not respond as well to treatment when a person has other chronic diseases.
• Some of the medicines used for depression can raise blood sugars.
• Doctors know they can lower blood sugar quickly and effectively with lifestyle choices and medicines. Depression is more challenging to treat.

But findings of a new study suggest a different approach. The study appears in the January/February issue of the journal Annals of Family Medicine. Blood sugar control and depression symptoms improved when both conditions were treated in a coordinated way.

What Changes Can I Make Now?

Diagnosing diabetes is straightforward -- a blood test shows a high blood sugar. There is no simple test for depression. It is diagnosed based on symptoms.

Feeling sad is only one of the symptoms of depression. Some people with depression would even deny sadness. Other important symptoms include:

• Little interest or pleasure in things you used to enjoy
• Sleep problems:
  
  • Trouble falling asleep
  • Waking up early and not being able to fall back to sleep
  • Sleeping too much
• Feeling tired, with no energy
• Poor appetite or overeating
• Feeling bad about yourself, feeling that you are a failure or have let people down
• Trouble concentrating
• Thinking that you would be better off dead or considering hurting yourself in some way

If you have both diabetes and depression, don't wait to treat the depression. Don't think that you need to get your blood sugar well controlled first. Once your blood sugar is in the safe range, getting treatment for depression will make taking care of your diabetes easier.

Treating the depression can help you to adopt better eating habits and get more exercise. This could mean lower blood sugar, perhaps with fewer medicines or at least lower doses.

What Can I Expect Looking to the Future?

You can expect scientists to discover a genetic basis for the link between depression and diabetes. This will lead to better treatments for both diseases.

Categories: Diabetes, Depression

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