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Treatment of black adults with diabetes and depression insured through Medicaid raises quality concerns

Adults with diabetes are more likely to suffer from major depression than adults without the disease. Treating depression has been shown to improve mood as well as outcomes in people with diabetes. However, in a study of four State Medicaid programs, blacks who suffered from both diabetes and depression were less likely to be treated for depression than whites (68 vs. 75 percent). Also, if treated, they were more likely than whites with depression and diabetes to receive older tricyclic antidepressants (TCAs) instead of newer selective serotonin reuptake inhibitors (SSRIs) (27 vs. 23 percent). TCAs may adversely alter blood sugar (glycemic) control, whereas SSRIs are less likely to do so.

In this study, supported in part by the Agency for Healthcare Research and Quality (HS11825 and HS09566), one-fourth of all Medicaid adult beneficiaries with depression and diabetes received TCAs in 1995, a time period when TCAs were already known to be less preferred than SSRIs for patients with diabetes. These findings raise concern about timely and equitable diffusion of newer treatment technologies, and the consequences of these lags for glycemic control as well as racial differences in the quality of mental health care. Researchers analyzed 1995 Medicaid claims data from Alabama, Georgia, New Jersey, and Wisconsin to investigate whether there were sociodemographic or insurance differences in the rates of depression diagnosis and treatment among nonelderly adults with diabetes.

Overall, 5 percent of the population studied was diagnosed with diabetes during 1995. Adults with diabetes had higher rates of depression than those without diabetes (10 vs. 7 percent). Among those diagnosed with depression, antidepressant treatment rates were higher in those with diabetes than those without diabetes (78 vs. 69 percent). This may be because adults with diabetes have more severe depression or they may have more frequent contact with health professionals, who are likely to prescribe antidepressants.

See "Diabetes and depression care among Medicaid beneficiaries," by Usha Sambamoorthi, Ph.D., Mark Olfson, M.D., Wenhui Wei, Ph.D., and Stephen Crystal, Ph.D., in the February 2006 Journal of Health Care for the Poor and Underserved 17, pp. 141-161.

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