The numerous common risk factors mean that certain interventions can improve outcomes of both disorders, and research findings provide insight into specific opportunities for clinicians to offer appropriate and effective intervention. “Medical providers and mental health practitioners must each take responsibility to assure that their patients have comprehensive assessments and treatments of both mental and medical conditions,” notted Malaspina.
“The identification of depression is an opportunity for early intervention in the risk for diabetes and vice versa. This comorbidity highlights the importance of collaborative care.”
A 2014 systematic review and meta-analysis3 of randomized controlled trials found that collaborative care significantly improved depression scores and HbA1c levels, as compared to controls. “Evidence shows that collaborative care is a cost-effective way of organizing and delivering care for depression in primary care settings,” study co-author Evan Atlantis, PhD, a senior research fellow at the University of Western Sydney, told Psychiatry Advisor.
In the “stepped care framework” recommended for depression in adults with a chronic physical health problem like diabetes, patients who do not respond to treatment are “stepped up” to a more intensive level of care, including lifestyle, psychological and pharmacological therapies. Once the patient reaches certain treatment targets, a structured maintenance plan for relapse prevention is typically implemented.“There is now sufficient evidence to suggest that lifestyle intervention integrated within collaborative care would be the most effective way to manage care for comorbid diabetes and depression,” said Atlantis.
In another study4 of a large NHANES sample, Malaspina and colleagues determined that insufficient sleep and lack of physical activity were two of the “risk factors for insulin resistance with the highest associations with both depression and diabetes incidence.” A potential barrier to increased exercise, however, is the lack of relevant local resources to support such efforts, suggests a 2015 study5 investigating the effects of various neighborhood features on depression in people with Type 2 diabetes. The researchers concluded that a greater level of greenness and more physical activity facilities and cultural services were associated with a lower risk of depression among participants.