01-08-2016 | Original Article
A collaborative care program for management of common mental disorders among diabetic patients in a primary healthcare setting
Published in: Journal of Public Health | Issue 4/2016
Login to get accessAbstract
Aims
Type 2 diabetes mellitus (T2DM) is a chronic condition with high and increasing prevalence. Psychiatric disorders are very common among these patients. We aimed to assess the effect of a collaborative care program for management of common mental disorders among T2DM patients on their metabolic outcomes.
Subjects and methods
In this before-after study, a group of T2DM patients was enrolled from nine chronic care centers of a primary healthcare service. A trained team managed both the psychiatric and metabolic conditions according to evidence-based guidelines. The primary care team was in collaborative contact with a specialized service at a Community Mental Health Center. Patients’ glycemic measures, lipid profile, and weight were measured 3 months after the psychiatric intervention.
Results
Among 2757 diabetic patients visited, 536 (19.44 %) were diagnosed as having a common mental disorder. Mean age of included patients (435) was 56.5 ± 9.74. Major depressive disorder and generalized anxiety disorder were the most common mental disorders with a frequency of 219 (50.3 %) and 197 (46.7 %), respectively. There was no statistically significant improvement in glycemic and metabolic control after the psychiatric intervention; however, control of blood pressure was improved. Moreover, significant improvements were observed in average glycosylated hemoglobin (HbA1c) (p < 0.001) and fasting plasma glucose (FPG) (p < 0.01) in patients with previously poor glycemic control.
Conclusion
Although management of psychiatric conditions in a collaborative care program yielded no significant effect on metabolic outcomes and glycemic control in the total sample, patients with poor glycemic control experienced significant improvement in FPG and HbA1c levels.