The Department of Family Medicine and Community Health, School of Medicine, University of Pennsylvania, Philadelphia
Diabetes Educ. 2010 Mar-Apr;36(2):284-92. doi: 10.1177/0145721709356115. Epub 2009 Dec 29.
The purpose of this study was to examine whether integrating depression treatment into care for type 2 diabetes mellitus among older African Americans improved medication adherence, glycemic control, and depression outcomes.
Older African Americans prescribed pharmacotherapy for type 2 diabetes mellitus and depression from physicians at a large primary care practice in west Philadelphia were randomly assigned to an integrated care intervention or usual care. Adherence was assessed at baseline, 2, 4, and 6 weeks using the Medication Event Monitoring System to assess adherence. Outcomes assessed at baseline and 12 weeks included standard laboratory tests to measure glycemic control and the Center for Epidemiologic Studies Depression Scale (CES-D) to assess depression.
In all, 58 participants aged 50 to 80 years participated. The proportion of participants who had 80% or greater adherence to an oral hypoglycemic (intervention 62.1% vs usual care 24.1%) and an antidepressant (intervention 62.1% vs usual care 10.3%) was greater in the intervention group in comparison with the usual care group at 6 weeks. Participants in the integrated care intervention had lower levels of glycosylated hemoglobin (intervention 6.7% vs usual care 7.9%) and fewer depressive symptoms (CES-D mean scores: intervention 9.6 vs usual care 16.6) compared with participants in the usual care group at 12 weeks.
A pilot randomized controlled trial integrating type 2 diabetes mellitus treatment and depression was successful in improving outcomes among older African Americans. Integrated interventions may be more feasible and effective in real-world practices with competing demands for limited resources.
本研究旨在探讨在老年非裔美国人中，将抑郁症治疗整合到 2 型糖尿病护理中是否能改善药物依从性、血糖控制和抑郁结局。
在费城西部一家大型初级保健机构接受 2 型糖尿病和抑郁症药物治疗的老年非裔美国人患者被随机分配到综合护理干预组或常规护理组。使用药物事件监测系统在基线、2、4 和 6 周评估药物依从性。在基线和 12 周评估的结局包括标准实验室检测以测量血糖控制和流行病学研究中心抑郁量表（CES-D）以评估抑郁。
共有 58 名年龄在 50 至 80 岁之间的参与者参与。在 6 周时，与常规护理组相比，接受口服降糖药（干预组 80%或更高的依从率为 62.1%，常规护理组为 24.1%）和抗抑郁药（干预组 80%或更高的依从率为 62.1%，常规护理组为 10.3%）的参与者在干预组中比例更高。与常规护理组相比，接受综合护理干预的参与者在 12 周时的糖化血红蛋白水平更低（干预组为 6.7%，常规护理组为 7.9%），抑郁症状更少（CES-D 平均得分：干预组为 9.6，常规护理组为 16.6）。
一项整合 2 型糖尿病治疗和抑郁症的试点随机对照试验成功地改善了老年非裔美国人的结局。综合干预措施在实际情况下可能更可行和有效，因为实际情况中存在对有限资源的竞争需求。
