Integration of Diabetes and Depression Care Is Associated with Glucose Control in Midwestern Federally Qualified Health Centers

Abstract

Background

The 2016 American Diabetes Association position statement emphasized that psychosocial and medical care should be integrated and provided to all people with diabetes.

Objective

To determine whether better integration of diabetes and depression care is associated with better glycemic control.

Design

Cross-sectional surveys of Midwestern federally qualified health center (FQHC) leaders and primary care providers (PCPs) in 2016. Responses were linked to FQHC-level data on the percentage of patients with uncontrolled diabetes (glycated hemoglobin ≥ 9%; 75 mmol/mol).

Participants

Midwest Clinicians’ Network–affiliated FQHC leaders, and PCPs at the FQHCs.

Main Measures

Multilevel models were used to determine associations between the percentage of patients with uncontrolled diabetes and FQHC and PCP characteristics; presence of diabetes and behavioral health care services; and PCPs’ perception of the stage of integration between diabetes and depression care services based on the transtheoretical model (i.e., pre-contemplation, contemplation, preparation, action, or maintenance).

Key Results

Response rates were 60% for the FQHC survey (N = 77) and 55% for the PCP survey (N = 538). In adjusted models, FQHCs in which PCPs perceived a higher stage of integration between diabetes and depression care had 3% fewer patients with uncontrolled diabetes per 1-level increase in integration stage (p = 0.01); on-site diabetes self-management education was associated with 7% fewer patients with uncontrolled diabetes (p < 0.01).

Conclusions

At Midwestern FQHCs, a higher stage of perceived integration of diabetes and depression care was associated with better FQHC-level glycemic control. Future studies are needed to elucidate what defines integration of diabetes and depression care services.

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Funding

N.L. is supported by the American Diabetes Association (1-18-JDF-037). N.L., E.S., W.W., M.T.Q, D.B., and M.C. are members of the NIDDK Chicago Center for Diabetes Translation Research (CCDTR) at the University of Chicago (P30 DK092949).

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N.L. is the guarantor of this work and had access to the data, designed the study, analyzed and interpreted the data, drafted the manuscript, and obtained funding. E.S., M.T.Q., A.C., S.G., and C.S. contributed to the design and data interpretation and reviewed/edited the manuscript. W.W. had access to the data, contributed to the design, analyzed and interpreted data, and reviewed/edited the manuscript. D.B. and M.C. contributed to the design and critically reviewed/edited the manuscript.

Corresponding author

Correspondence to Neda Laiteerapong MD, MS.

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Laiteerapong, N., Staab, E.M., Wan, W. et al. Integration of Diabetes and Depression Care Is Associated with Glucose Control in Midwestern Federally Qualified Health Centers. J GEN INTERN MED (2021). https://doi.org/10.1007/s11606-020-06585-5

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KEY WORDS

  • diabetes
  • depression
  • integrated care
  • glucose control