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Depression worsens the health and quality of life of people with diabetes

Diabetes is the leading cause of cardiovascular disease, stroke, blindness, and lower limb amputations. People with diabetes are also twice as likely to suffer from depression than people without diabetes. A recent review of the literature points out the adverse health outcomes for people who have both diabetes and depression, the challenges of treating these coexisting conditions in a fragmented healthcare system, and the need for integrated care to improve the quality of care for such patients. Leonard E. Egede, M.D., M.S., of the Medical University of South Carolina, cites the overwhelming evidence that people with diabetes who are also depressed have worse glycemic control, more diabetes complications, more lost productivity and disability, worse quality of life, and higher healthcare costs than people with diabetes who are not depressed.

People with diabetes and depression are less likely than their nondepressed counterparts to adhere to the multiple medications and self-care behaviors (such as proper diet and exercise and daily blood glucose monitoring) needed to control their diabetes. Those with major depression are also over twice as likely to die over a 3-year period.

Several studies suggest that collaborative treatment models for depression in people who have diabetes improve depression. However, this approach has little to no effect on diabetes outcomes, unless some diabetes education or other diabetes care interventions are added. Similarly, depression is often overlooked by primary care doctors who treat people with diabetes because their symptoms, such as fatigue and weight change, are often similar to depression. The fragmentation of care between general health and mental health services is also a problem. Dr. Egede points out the need for integrated care to improve outcomes for both conditions in these medically complex patients. His study was supported by the Agency for Healthcare Research and Quality (HS11418).

More details are in "Disease-focused or integrated treatment: Diabetes and depression," by Dr. Egede, in the July 2006 Medical Clinics of North America 90, pp. 627-646.

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