Diabetes treatment should also cover mental health
A UBC researcher says there is a lot more to treating people with Type 2 diabetes than just moderating their diet and prescribing exercise.
And if that’s all you do, you might be missing a key ingredient to their care.
Lesley Lutes, a clinical health psychologist who directs the PhD program in clinical psychology at UBC’s Okanagan campus, has done extensive research with people who live with adult onset, or Type 2 diabetes (T2D).
Many people diagnosed with adult on-set diabetes also experience higher rates of depression and other distress. If left untreated, Lutes says these issues can have a long-lasting impact on a person’s physical and emotional health.
“People with T2D are twice as likely to have symptoms of depression,” says Lutes. “And these depressive symptoms may interfere with glycemic control and adherence to the prescribed treatment.”
Lutes, received a $450,000 grant to develop a treatment strategy that incorporated both behavioural and medical interventions for patients with uncontrolled T2D.
The study, called the Collaborative Care Management for Distress and Depression in Rural Diabetes ran in North Carolina, as T2D is significantly prevalent in the southeastern U.S.
The three-year study looked at the feasibility and effectiveness of a collective, multi-step delivery model for patients who struggle to control their diabetes and show depressive or diabetes-related distress symptoms compared to usual primary care treatment.
Treatment was delivered by a team of behavioural providers: a nurse care manager who delivered small lifestyle changing coaching, a doctoral student in clinical psychology or a psychologist who provided cognitive behavioural treatment sessions, and a community health worker who gave diabetes navigation and social support.
“It was an innovative way to treat the patient at an integrated primary care setting,” Lutes explains.
“The visits would piggyback each other and every aspect of the patient’s health would be considered at the one visit.”
At the same time, each patient was given ideas for small changes to their lifestyle — instead of sweeping changes that might be impossible to maintain.
The goals were small, reasonable, consistent and achievable.
“For example, you can’t ask a 65-year-old person to suddenly stop eating foods they have been eating their entire life.
Instead of saying ‘no fried foods’, we would suggest a smaller portion with a larger helping of healthy vegetables. Or perhaps fewer fried meals in one week, instead of every meal involving fried foods.”
The design and rationale of this study were published this month in the Contemporary Clinical Trials journal.
The treatment outcomes, which Lutes presented last month at the American Diabetes Association annual meeting, were a huge success.
Many study participants had a significant decrease in their blood sugar levels without increasing medication.
Specifically, researchers saw a threefold decrease in the blood sugar levels of patients in the integrated care group compared to only a third of that result seen in the primary care group.
Most notably, there was a huge impact on the mental and physical health of each participant—which directly influenced the ultimate health outcomes in the study.
“We proved that the integrated care model worked and it worked well. It was feasible, it was workable and it was efficient,” she says. “It was truly healthcare as it was intended—mental health and physical health working side by side.”