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Efficacy of Depression Management in an Integrated Psychiatric-Diabetes Education Clinic for Comorbid Depression and Diabetes Mellitus Types 1 and 2

      Abstract

      Objectives

      Patients with type 1 and type 2 diabetes mellitus (DM) are 2 times as predisposed to developing mood disorders, such as major depressive disorder (MDD), compared with patients without diabetes. Management of comorbid MDD and DM remains a challenge because patients often suffer from poor medication compliance, lifestyle factors and refractory depression. Integration of psychiatric care into diabetes education clinics (DECs) has been suggested as an effective method of managing the comorbid conditions. As this strategy is being implemented into clinical care, its effectiveness in practice warrants further research.

      Methods

      A retrospective chart review of 24 patients (10 men and 14 women) followed by an integrated psychiatry-DEC in Newmarket, Ontario, Canada, between April 2016 and July 2019 was performed. Depressive symptom severity at each appointment was assessed with the Patient Health Questionnaire-9 (PHQ-9) depression rating scale.

      Results

      There was no significant change in PHQ-9 depression rating scale scoring between the first and most recent appointments (paired t test, p=0.356); however, patients who had improved PHQ-9 scoring were more likely to have more clinic visits (analysis of variance, p=0.0271). A significant negative correlation was found between both number of visits (Pearson coefficient, −0.56; p=0.005) and overall time the patients were followed by DEC (Pearson coefficient, −0.42; p=0.040) and PHQ-9 score changes between the first and most recent appointments. PHQ-9 change between individual appointments also displayed a positive correlation with time between appointments (Pearson coefficient, 0.26; p=0.027).

      Conclusions

      Regular follow up in a psychiatry-DEC service might be beneficial in managing MDD symptom severity for comorbid MDD and DM.

      Résumé

      Objectifs

      Les patients atteints du diabète sucré (DS) de type 1 et de type 2 sont 2 fois plus prédisposés que les patients non diabétiques à avoir des troubles de l’humeur tels que la dépression majeure (DM). La prise en charge de la cooccurrence de la DM et du DS demeure un enjeu puisque les patients souffrent souvent de leur observance médiocre aux médicaments, des facteurs liés à leur mode de vie et de dépression réfractaire. L’intégration des soins psychiatriques aux cliniques d’enseignement sur le diabète (CED) a été considérée comme une méthode de prise en charge efficace des affections comorbides. Puisque cette stratégie est mise en place dans les soins cliniques, une recherche plus poussée est justifiée pour évaluer son efficacité dans la pratique.

      Méthodes

      Nous avons réalisé une étude rétrospective de dossiers de 24 patients (10 hommes et 14 femmes) suivie d’une CED en psychiatrie intégrée à Newmarket, en Ontario, au Canada, entre avril 2016 et juillet 2019. Nous avons effectué l’évaluation de la gravité des symptômes de dépression à chacun des rendez-vous à l’aide de l’échelle d’évaluation de la dépression du PHQ-9 (Patient Health Questionnaire-9).

      Résultats

      Nous n’avons observé aucun changement significatif dans les scores à l’échelle d’évaluation de la dépression du PHQ-9 entre le premier et le plus récent rendez-vous (test t pour échantillons appariés, p = 0,356); toutefois, les patients qui avaient eu un meilleur score au PHQ-9 étaient plus susceptibles d’avoir de nombreuses visites cliniques (analyse de variance, p = 0,0271). Nous avons observé une corrélation significative entre le nombre de visites (coefficient de Pearson, −0,56; p = 0,005) et la durée totale du suivi des patients par la CED (coefficient de Pearson, −0,42; p = 0,040), et des changements dans les scores au PHQ-9 entre le premier et le plus récent rendez-vous. Les changements au PHQ-9 entre les rendez-vous individuels ont également montré une corrélation positive avec la durée entre les rendez-vous (coefficient de Pearson, 0,26; p = 0,027).

      Conclusions

      Le suivi systématique au service de la CED en psychiatrie devrait être bénéfique à la prise en charge des symptômes graves de DM lors de la cooccurrence de DM et de DS.

      Keywords

      Mots clés

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