Diabetes Treatment News: Integrated Diabetes-Depression Treatment Improves Outcome

/ January 16th, 2013/ Posted in Mental Health / No Comments »

Integrated Diabetes-Depression Treatment Improves Outcome

Integrating the treatment of type 2 diabetes and depression improves outcomes, including glycemic control and depression, for patients in the primary care setting, according to a study published in the January/February issue of the Annals of Family Medicine.

MONDAY, Jan. 16 (HealthDay News) — Integrating the treatment of type 2 diabetes and depression improves outcomes, including glycemic control and depression, for patients in the primary care setting, according to a study published in the January/February issue of the Annals of Family Medicine.

Hillary R. Bogner, M.D., of the University of Pennsylvania in Philadelphia, and colleagues conducted a randomized controlled trial — involving 180 primary care patients receiving pharmacotherapy for type 2 diabetes and depression — to determine whether an integrated treatment approach could improve glycemic control, adherence to medications, and depression symptoms. Patients received either integrated care, which involved additional education and guideline-based treatment recommendations and frequent monitoring of adherence and clinical status, or usual care. Depression was measured using the nine-item Patient Health Questionnaire (PHQ-9); medication adherence was assessed using the Medication Event Monitoring System; and glycated hemoglobin (HbA1c) was used to quantify the patient’s level of glycemic control.

The investigators found that, at 12 weeks, 60.9 percent of patients receiving integrated care achieved an HbA1c level of less than 7 percent, compared with 35.7 percent of those who received usual care. Patients in the integrated care group were also more likely to achieve remission of depression, with 58.7 percent scoring less than five on the PHQ-9 questionnaire compared with only 30.7 percent of patients receiving usual care.

“Our results show the usefulness of a simple, brief, integrated care management intervention for primary care patients with type 2 diabetes and depression,” the authors write.

NM hospital hires its first endocrinologist

The hospital recently hired a doctor with six years of experience treating American Indian patients to assist physicians who treat the most complex diabetic patients in the county.

Dr. George Ang, born in the Philippines, started work in Farmington in December as a physician at San Juan Health Partners. He’s the first endocrinologist at the health partnership or San Juan Regional Medical Center, hospital officials said.

Ang previously worked six years in Gallup at Rehoboth McKinley Christian Hospital and moved to Farmington in search of more patients. He expects to stay busy because of this area’s high rates of diabetes, especially among American Indians.

Endocrinologists are internal medicine physicians with additional training with the body’s glands that produce hormones.

While some endocrinologists specialize in treating health issues such as infertility or excessive or limited growth, Ang is content to work primarily with diabetic patients.

“I just happened to really love diabetes,” he said. “So this was a good fit for me because there is a huge need (for an endocrinologist) among the Native Americans.”

Local diabetes rates have long concerned health officials. Statewide, New Mexico has a diabetes rate of 10 percent. Among American Indians, more than 16 percent of the population has diabetes, said Sandra Grunwaldt, the diabetic education coordinator at the hospital.

Ang said an unhealthy lifestyle coupled with a wariness to medication contribute to the discrepancy in diabetes rates among ethnicities.

Ang said personable care can improve the chance of success when treating a patient for diabetes. Especially when treating American Indian patients, he said.

“They don’t like another specialist telling them they have to do this and this. That doesn’t really work, scaring them into shaping up,” Ang said. “What I’ve found is key to being successful is building trust, especially among the Native Americans.”

Building trust comes from congratulating patients for shedding a few pounds. Or by memorizing the generic equivalents to big-name medications that are available at Walmart at a lower cost, he said.

Accepting bad health problems as a way of life is also a problem when it comes to treating Navajo diabetes patients, Ang said.

“Some think (kidney disease) is a part of diabetes. Grandma and great grandma were on dialysis, mom is on dialysis and I’ll get kidney disease. That’s a big misconception,” Ang said. “We know we can prevent that but it’s difficult. … It’s a daily battle.”

The hospital is trying to improve treatment for all diabetic patients, Grunwaldt said. Ang’s hire is at one end of the spectrum, as he will treat the most complex and difficult cases.

Because of Ang “we can see people affected by the more severe, long-term effects of diabetes and reduce their risk of getting to the point,” Grunwaldt said.

The hospital is also trying to improve treatment and awareness for people who do not yet have the disease.

In addition to offering free six-week-long diabetes education courses to diabetic patients, the hospital will start at the end of January offering a Lifestyle Balance Program. It’s a similar education program for people who are at risk of getting diabetes, Grunwaldt said.

For treating diabetes, “lifestyle is key,” Ang said. “It’s more effective than any drug.”

Type 2 diabetes patients with hypertension do not need to rush to drug treatment

People with type 2 diabetes have to keep a close eye on their blood pressure. But that does not mean they have to start taking blood pressure drugs the minute they are diagnosed.

Middle-aged diabetes patients with high blood pressure have time to learn how to manage their blood pressure without the use of medications.

Waiting up to a year before starting drug treatment for high blood pressure leads to only a small reduction in life expectancy.
Learn to control your blood pressure without drugs.

High blood pressure – or hypertension – is harmful for anyone with or without diabetes. Having said that, diabetes patients with high blood pressure have an especially high risk for stroke, heart disease, kidney failure, loss of vision, and amputations.

Even though controlling high blood pressure can prevent these health problems, doctors and patients alike often fail to take the steps needed to lower blood pressure.

Many patients do not make the proper lifestyle changes, while their doctors can be hesitant to put them on additional drugs.

Until recently, the consequences of these treatment delays had not been measured. Neda Laiteerapong, M.D., of the University of Chicago, and colleagues used computer software to find out how much harm is caused by different delays in managing blood pressure in recently diagnosed diabetes patients.

The researchers found that a one-year delay causes only small damage. However, waiting 10 years or more can cause as much damage as smoking does in patients with heart disease.

According to both the American Diabetes Association and the National Institutes of Health, diabetes patients should aim for a blood pressure below 130/80 mmHg, a target that is lower than that recommended for the general public.

Yet, about two-thirds of adults with diabetes do not reach that goal, either because they lack access to proper health care or due to what can be called “clinical inertia” – when patients do not make lifestyle changes or when doctors are hesitant to push additional medications.

Most experts recommend that diabetes patients with moderately high blood pressure starting taking blood pressure medications within three months. For those with dangerously high blood pressure, they recommend starting drug treatment immediately.

The problem with beginning drug treatment so early is that patients do not have enough time to learn good habits and make the necessary lifestyle changes. Starting drug treatment early also means that patients have to start paying for those drugs sooner.

“We ask patients with diabetes to do a billion things,” says Dr. Laiteerapong. Patients have to juggle a variety of tasks, including testing their blood sugar, counting carbohydrates, and exercising for half an hour each day.

“Most, if not all, of this is new to them,” Dr. Laiteerapong explains. “They need time to adapt. It’s important to do this right, but our results say it’s not that important to do it so fast.”

The study’s findings suggest that doctors should work with patients to help them learn the necessary skills instead of racing into drug treatment.

According to the authors, diabetes patients with high blood pressure have “at least up to one year to focus on diabetes self-management and lifestyle modification.” That is, they have more time.

For their study, Dr. Laiteerapong and colleagues ran published data through computer software to determine the extent to which delaying hypertension treatment caused harm to recently diagnosed type 2 diabetes patients between 50 and 59 years of age.

“Among middle-aged adults with diabetes, the harms of a one-year delay in managing blood pressure may be small,” the researchers conclude.

“Health care providers may wish to focus on diabetes management alone in the first year after diagnosis to help patients establish effective self-management and lifestyle modification.

However, after the first year, it is clear that achieving and maintaining tight blood pressure control among US middle-aged adults with diabetes has the potential to generate substantial population-level health benefits.”

In other words, blood pressure drugs can wait. But after one year, it is clear that drug treatment is extremely valuable to the health of patients.

The study – which received financial support from the National Institutes of Health – is published in the Journal of General Internal Medicine.

Nearly 26 million individuals are affected by diabetes in the United States each year, with about seven million people going undiagnosed. Diabetes is a chronic metabolic disease with no cure in which a person has high blood sugar because the body does not produce enough insulin (Type 1) or because cells do not respond to the insulin that is produced (Type 2).

There are three main types of diabetes: Type 1, Type 2 and Gestational. Several groups of oral drugs, are effective for Type 2, such as Glucophage, Glucotrol, and Prandin, among many others. The therapeutic combination in Type 2 may eventually include injected insulin as symptoms worsen.

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