A Collaborative Approach to Managing Depression & Diabetes

Published studies have demonstrated that many patients with diabetes and cardiovascular disease (CVD) often have comorbid depression. In individuals with diabetes or CVD, depression has been linked to poor self-management of their physical health, an increased risk for complications, and higher morbidity. Due to feelings of helplessness and hopelessness that accompany depression, the management of these patients is often more complicated than for those who are not depressed. Compounding the problem is that complications of diabetes and CVD can exacerbate any previously existing depression. Exploring a New Depression Intervention In the December 30, 2010 New England Journal of Medicine, my colleagues and I published data from a randomized controlled trial in which we tested a primary care intervention called TEAMcare. In this intervention, nurses worked together with patients and healthcare teams to manage care using evidence-based guidelines for both depression and physical diseases together. The TEAMcare intervention involved having nurse care managers coach patients, monitor disease control and depression, and work with patients’ primary care physicians (PCPs) to make changes in medications and lifestyle when treatment goals were not reached. Nurses were supervised weekly by psychiatrists and PCPs who made recommendations about medication changes that nurses then communicated to patients’ PCPs. “Patients who received the TEAMcare intervention were significantly less depressed, and also had improvements in blood glucose, LDL cholesterol, and systolic blood pressure levels.” Working collaboratively, nurses and patients set realistic step-by-step goals for reducing depression as well as blood glucose, blood pressure, and cholesterol levels. To reach the goals set forth in the TEAMcare intervention, nurses regularly monitored patients’ mental and physical health and offered recommendations to patients’ PCPs...