It's no secret that mental illness and physical health are closely linked. Diabetes is a case in point: People who have it are twice as likely to suffer from depression, and at the same time studies have shown that depression is a risk factor for diabetes.
As a primary care physician in Philadelphia, Hillary Bogner, MD, sees lots of patients struggling with both diabetes and depression—and expects the numbers to grow in the future. "Diabetes is such a huge problem in primary care right now," she says, and "the rates of depression are so high in patients with diabetes, and diabetes patients with depression do so much worse than patients without."
Hillary Bogner, MD
Assistant Professor of Family Medicine and Community Health, University of
ADA Research Funding
Clinical Translational Research Award
Research shows that treating depression can have dramatic effects on physical health. A 2007 study, for example, showed that treating depression in older diabetes patients reduced the likelihood of death by half in the five years that followed. And it's clear that it improves mental health, too. But what Bogner, an assistant professor at the University of Pennsylvania, wants to find out is whether treating depression has a direct impact on the symptoms of diabetes.
What connects diabetes and depression remains something of a mystery. Part of the relationship is coincidental: Adherence to routines and schedules is very important in managing both depression and diabetes, but people who suffer from depression are less likely to take medications and deal with their diabetes, which makes things worse. It's a vicious cycle that in turn can amplify the symptoms of depression. "Poor functioning may make it hard to get to the pharmacy or open the bottle. Poor cognition may make you forget to take your medicines," Bogner says. "People are looking very hard to try to figure out the connections, but adherence . . . comes up over and over."
So Bogner is looking into how to help people take the medications they need. "We focus on adherence because that's so important, for both depression and diabetes," she says. With a grant from the American Diabetes Association, Bogner is studying whether working with an educator specially trained for the study can help boost a set of key indicators, like taking medication for diabetes and depression more than 80 percent of the time and having fewer symptoms of depression.
To do that, Bogner is recruiting 280 people over the age of 50 who have both type 2 diabetes and depression. Using pill bottles outfitted with special caps that record each time the bottle is opened, the research team measures when patients took their medications. Half of the patients have one-on-one counseling sessions for three months with a specially trained educator who works with them to figure out ways they can better adhere to their medication schedules. The other half get standard care from their primary care physicians.
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Throughout the study, Bogner and her team record A1C levels, bouts of depression, and how regularly patients take their medications for both diabetes and depression. After the three months are up, participants are followed for another three months to see if the techniques and lessons learned have a lasting impact. In 2009, Bogner published the results of a pilot study that looked at 58 African Americans between 50 and 80 years old, all with both type 2 diabetes and depression. The pilot was a test run for the larger trial, and the results were dramatic. Participants who had additional meetings with an educator were six times as likely as those with standard care to take their depression medications regularly, and more than twice as likely to take oral medications for their diabetes. “The pilot results looked very good, so we’re excited” about the promise of the full study, she says.
If the larger study shows similar results, Bogner says techniques of counseling for diabetes and depression together could be taught to diabetes educators working in primary care practices. Recognizing the connection between diseases of the mind and body—even if the relationship isn't fully understood—could go a long way toward delivering better treatment.