Kaiser Says Coordinated Diabetes Care Can Also Reduce Depression

Coordinating the care of diabetic patients with cardiovascular and mental health treatments has improved their overall outcomes as well as reduced incidents of depression, Kaiser Permanente has reported.

Kaiser medical practices in California and Colorado participated in the nationwide Compass initiative funded over the past three years by the Center for Medicare and Medication Innovation.

According to Kaiser officials, the initiative resulted in 23% of diabetes patients participating in Compass controlling their glucose levels over the long term, 58% achieving long-term blood pressure control and 40 percent pushing their diagnosed depression into remission. The results were published in the most recent edition of the journal General Hospital Psychiatry.

“Depression is a chronic disease like diabetes,” said Karen Coleman, a scientist with Kaiser's department of research and evaluation in Southern California. “Healthy behavioral changes like sleep, exercise and better eating, can improve diabetes and depression. If medications are given for depression, they can be managed in a collaborative care model just like medications for diabetes.”

Much scholarship on diabetes has linked the chronic disease to depression, and vice-versa. Diabetes patients have shown to have a greater risk of being depressed, or at least exhibit behavioral traits that are similar to depression. The American Diabetes Association devotes a page of it website specifically to depression.

“Depression can get you into a vicious cycle,” a section of the website reads. “It can block good diabetes self-care. If you are depressed and have no energy, chances are you will find such tasks as regular blood sugar testing too much. If you feel so anxious that you can't think straight, it will be hard to keep up with a good diet. You may not feel like eating at all. Of course, this will affect your blood sugar levels.”

As part of the Compass initiative, care managers at the Kaiser and other participating sites conducted ongoing outreach to patients, with both primary care physicians and psychiatrists reviewing case data. When a patient's health was not improving or their diabetes was out of control, outreach was increased to them to a weekly basis.

“This was a successful wide scale implementation of a collaborative care model that demonstrated it can be used in a variety of healthcare settings with positive effects for providers and patients,” Coleman said. “It was challenging for many care managers because there’s a lot of work in counseling patients. But overall they had a very positive experience because they did see change in their patients.