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A Collaborative Care Program for Management of Common Mental Disorders Among Diabetic Patients in a Primary Healthcare Setting Publisher



Moinfar Z1 ; Sedaghat M1 ; Abolhassani F2 ; Sharifi V3 ; Moinfar Z1 ; Eftekhari S5 ; Mirzaaghaee F5
Authors
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Authors Affiliations
  1. 1. Department of Community & Preventive Medicine, School of Medicine, Tehran University of Medical Sciences (TUMS), P.O. Box 14155-6447, Tehran, Iran
  2. 2. Health Services Department, National Institute of Health Research, Tehran University of Medical Sciences (TUMS), Tehran, Iran
  3. 3. Psychiatry, Department of Psychiatry, Roozbeh Hospital, Tehran University of Medical Sciences (TUMS), Tehran, Iran
  4. 4. Department of Neuroanatomy and Molecular Brain Research, Ruhr-Universitat Bochum, Bochum, Germany
  5. 5. Department of Occupational Medicine, Faculty of Medicine, Tehran University of Medical Sciences (TUMS), Tehran, Iran

Source: Journal of Public Health (Germany) Published:2016


Abstract

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. © 2016, Springer-Verlag Berlin Heidelberg.
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