The 2016 American Diabetes Association position statement emphasized that psychosocial and medical care should be integrated and provided to all people with diabetes.
To determine whether better integration of diabetes and depression care is associated with better glycemic control.
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).
Midwest Clinicians’ Network–affiliated FQHC leaders, and PCPs at the FQHCs.
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).
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).
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.
This is a preview of subscription content, access via your institution.
We’re sorry, something doesn't seem to be working properly.
Please try refreshing the page. If that doesn't work, please contact support so we can address the problem.
Young-Hyman D, de Groot M, Hill-Briggs F, Gonzalez JS, Hood K, Peyrot M. Psychosocial Care for People With Diabetes: A Position Statement of the American Diabetes Association. Diabetes Care 2016;39:2126–2140
Ali S, Stone MA, Peters JL, Davies MJ, Khunti K. The prevalence of co-morbid depression in adults with Type 2 diabetes: a systematic review and meta-analysis. Diabet Med 2006;23:1165–1173
Peyrot M, Rubin RR. Levels and risks of depression and anxiety symptomatology among diabetic adults. Diabetes Care 1997;20:585–590
Anderson RJ, Freedland KE, Clouse RE, Lustman PJ. The prevalence of comorbid depression in adults with diabetes: a meta-analysis. Diabetes Care 2001;24:1069–1078
Carnethon MR, Biggs ML, Barzilay JI, et al. Longitudinal association between depressive symptoms and incident type 2 diabetes mellitus in older adults: the cardiovascular health study. Arch Intern Med 2007;167:802–807
Nouwen A, Winkley K, Twisk J, et al. Type 2 diabetes mellitus as a risk factor for the onset of depression: a systematic review and meta-analysis. Diabetologia 2010;53:2480–2486
Gonzalez JS, Safren SA, Cagliero E, et al. Depression, self-care, and medication adherence in type 2 diabetes: relationships across the full range of symptom severity. Diabetes Care 2007;30:2222–2227
Egede LE, Ellis C, Grubaugh AL. The effect of depression on self-care behaviors and quality of care in a national sample of adults with diabetes. Gen Hosp Psychiatry 2009;31:422–427
Katon WJ, Rutter C, Simon G, et al. The association of comorbid depression with mortality in patients with type 2 diabetes. Diabetes Care 2005;28:2668–2672
Ciechanowski PS, Katon WJ, Russo JE. Depression and diabetes: impact of depressive symptoms on adherence, function, and costs. Arch Intern Med 2000;160:3278–3285
Schram MT, Baan CA, Pouwer F. Depression and quality of life in patients with diabetes: a systematic review from the European depression in diabetes (EDID) research consortium. Curr Diabetes Rev 2009;5:112–119
Laiteerapong N, Karter AJ, Liu JY, et al. Correlates of quality of life in older adults with diabetes: the Diabetes & Aging study. Diabetes Care 2011;34:1749–1753
Vogel ME, Kanzler KE, Aikens JE, Goodie JL. Integration of behavioral health and primary care: current knowledge and future directions. J Behav Med 2017;40:69–84
Cohen DJ, Balasubramanian BA, Davis M, et al. Understanding Care Integration from the Ground Up: Five Organizing Constructs that Shape Integrated Practices. J Am Board Fam Med 2015;28 Suppl 1:S7–20
Atlantis E, Fahey P, Foster J. Collaborative care for comorbid depression and diabetes: a systematic review and meta-analysis. BMJ Open 2014;4:e004706
Grazier KL, Smiley ML, Bondalapati KS. Overcoming Barriers to Integrating Behavioral Health and Primary Care Services. J Prim Care Community Health 2016;7:242–248
Jones EB, Ku L. Sharing a Playbook: Integrated Care in Community Health Centers in the United States. Am J Public Health 2015:e1–e7
Centers for Disease Control and Prevention (Ed.). Nat Diabetes Stast Rep, 2017. 2017
Lee JPD, Brazeal M Msw L, Choi HPD, Rehner TAPD, McLeod SM, Jacobs CM. Physical and psychosocial factors associated with depression among adults with type 2 diabetes mellitus at a Federally Qualified Healthcare Center. Soc Work Health Care 2018;57:834–850
Wang Y, Lopez JM, Bolge SC, Zhu VJ, Stang PE. Depression among people with type 2 diabetes mellitus, US National Health and Nutrition Examination Survey (NHANES), 2005-2012. BMC Psychiatr 2016;16:88
Fauth J, Tremblay G: The Integrated Care Evaluation Project: Full Report. Antioch University New England, 2011
Lardiere MR, Jones E, Perez M: NACHC 2010 Assessment of Behavioral Health Services Provided in Federally Qualified Health Centers. Centers NAoCH, Ed., 2011
A Framework for Measuring Integration of Behavioral Health and Primary Care [article online], Available from https://integrationacademy.ahrq.gov/products/ibhc-measures-atlas/framework-measuring-integration-behavioral-health-and-primary-care. Accessed 7/24/2019
AIMS Center (Advancing Integraged Mental Health Solutions) [article online], Available from https://aims.uw.edu/. Accessed 7/24/2019
Heath B, Wise Romero P, Reynolds K. A standard framework for levels of integrated care. Washington, DC: SAMHSA-HRSA Center for Integrated Health Solutions Retrieved from https://wwwintegrationsamhsagov/integrated-care-models/A_Standard_Framework_for_Levels_of_Integrated_Healthcarepdf 2013;
Peek CJ, National Integration Academy Council (Eds.). Lexicon for Behavioral Health and Primary Care Integration: Concepts and Definitions Developed by Expert Consensus. Rockville, MD, 2013 publ. no. AHRQ Publication No.13-IP001-EF)
Sanchez K, Thompson S, Alexander L. Current strategies and barriers in integrated health care: a survey of publicly funded providers in Texas. Gen Hosp Psychiatry 2010;32:26–32
NORC at the University of Chicago. National Association of Community Health Centers ASsessment of FQHCs' Integrated Behavioral Health Services. 2011;
Prochaska JO, Velicer WF. The transtheoretical model of health behavior change. Am J Health Promot 1997;12:38–48
Foster-Johnson L, Kromrey JD. Predicting group-level outcome variables: An empirical comparison of analysis strategies. Behav Res Methods 2018;50:2461–2479
Tibshirani R. Regression Shrinkage and Selection via the Lasso. J R Stat Soc Ser B Methodol 1996;58:267–288
Laiteerapong N, Fairchild PC, Chou CH, Chin MH, Huang ES. Revisiting Disparities in Quality of Care Among US Adults With Diabetes in the Era of Individualized Care, NHANES 2007-2010. Med Care 2015;53:25–31
Chin MH, Kirchhoff AC, Schlotthauer AE, et al. Sustaining quality improvement in community health centers: perceptions of leaders and staff. J Ambul Care Manage 2008;31:319–329
Chin MH, Cook S, Drum ML, et al. Improving diabetes care in midwest community health centers with the health disparities collaborative. Diabetes Care 2004;27:2–8
Paul R, Lim CY, Curtis AB, et al. Assessing the association of diabetes self-management education centers with age-adjusted diabetes rates across U.S.: Aspatial cluster analysis approach. Spatial Spatio-temporal Epidemiol 2018;24:53–62
Ellis SE, Speroff T, Dittus RS, Brown A, Pichert JW, Elasy TA. Diabetes patient education: a meta-analysis and meta-regression. Patient Educ Couns 2004;52:97–105
Norris SL, Lau J, Smith SJ, Schmid CH, Engelgau MM. Self-management education for adults with type 2 diabetes: a meta-analysis of the effect on glycemic control. Diabetes Care 2002;25:1159–1171
He X, Li J, Wang B, et al. Diabetes self-management education reduces risk of all-cause mortality in type 2 diabetes patients: a systematic review and meta-analysis. Endocrine 2017;55:712–731
Li R, Shrestha SS, Lipman R, et al. Diabetes self-management education and training among privately insured persons with newly diagnosed diabetes--United States, 2011-2012. MMWR Morb Mortal Wkly Rep 2014;63:1045–1049
Katon WJ, Lin EH, Von Korff M, et al. Collaborative care for patients with depression and chronic illnesses. N Engl J Med 2010;363:2611–2620
Wozniak L, Soprovich A, Rees S, Al Sayah F, Majumdar SR, Johnson JA. Contextualizing the Effectiveness of a Collaborative Care Model for Primary Care Patients with Diabetes and Depression (Teamcare): A Qualitative Assessment Using RE-AIM. Can J Diabetes 2015;39 Suppl 3:S83–91
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).
Conflict of Interest
The authors declare that they do not have a conflict of interest.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
About this article
Cite this article
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
- integrated care
- glucose control