A Comprehensive Intervention for Diabetes and Comorbid Depression in Primary Care

The study involves a 32-week randomized controlled trial in primary care of a comprehensive diabetic and depression intervention in patients with type 2 diabetes and comorbid MDD, compared to a group treated with usual care for MDD plus disease self-management and measurement-based care for diabetes.

Study Overview

• Status: Completed
• Conditions: Type 2 Diabetes; Major Depressive Disorder
• Intervention / Treatment: Behavioral: Diabetes and depression intervention; Behavioral: Diabetes intervention

Detailed Description

The overarching goal of the study is to translate research-based treatment procedures that have been shown to improve outcomes for both DM and MDD for use in primary care. More specifically, the aims are: 1) to evaluate the benefits of CDDI in improving diabetic outcomes compared to usual care for MDD plus disease self-management for diabetes; 2) to evaluate the benefits of CDDI in improving depression outcomes compared to the UC for MDD treatment protocol; and 3) to evaluate the benefits of CDDI in terms of improved (1) cardiovascular risk factors (blood pressure, body mass index, lipids, and abdominal fat), (2) levels of exercise and better diet, (3) clinician and patient satisfaction with care, (4) fidelity to treatment guidelines, and (5) cognitive function.

• Study Type: Interventional
• Enrollment (Actual): 20
• Phase: Phase 4

Contacts and Locations

Study Locations

• United States
  • Texas
    • Dallas, Texas, United States, 75390
      • Family and Community Medicine Clinic, University of Texas Southwestern Medical Center

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 21 years to 70 years (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Meets DSM-IV criteria for single or recurrent nonpsychotic MDD, and whom the physician deems it necessary to start on an antidepressant.
• Meets clinical criteria for type 2 diabetes as follows: (1) on pharmacological treatment for type 2 diabetes and/or (2) fasting plasma glucose > 126mg/dL on 2 separate occasions or an abnormal oral glucose tolerance test (OGTT) (2-hours post load glucose ≥ 200mg/dL).
• HbA1C > 7
• Ability and willingness to provide written informed consent
• Hamilton Rating Scale for Depression (HRSD) score ≥ 14
• Not on antidepressant medication for at least 2 weeks prior to screen (or 6 weeks in the case of fluoxetine or monoamine oxidase inhibitors - MAOIs)

Exclusion Criteria:

• Women who are pregnant or breastfeeding
• Type 1 diabetes
• General medical conditions that contraindicate use of antidepressant medications
• Unstable medical illnesses, such as uncontrolled hypertension or symptomatic cardiovascular disease, such as congestive heart failure or angina
• Current or past psychotic disorders including bipolar disorder (I, II, or NOS), schizophrenia, or schizoaffective disorder; anorexia; bulimia
• High risk for being unable to complete the study due to hospitalization, suicide attempts, significant self-mutilation, or other self-injurious or destructive behavior
• Concomitant pharmacological or psychotherapeutic treatment including but not limited to anxiolytics, neuroleptics, mood stabilizers, and/or other agents without proven antidepressant efficacy; cognitive behavioral therapy; current use of other medications that would be contraindicated with antidepressant treatment, as determined by the study doctor
• History of current substance or alcohol dependence requiring detoxification within the last 6 months
• Currently suicidal or considered a high suicide risk
• Require inpatient treatment for their depression

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Diabetes and depression intervention; Measurement based care for diabetes and depression, disease self management for diabetes and depression	Behavioral: Diabetes and depression intervention; Disease self management for diabetes and depression; Other Names: Measurement based care; Disease self management
Active Comparator: Diabetes intervention; Measurement based care for diabetes, disease self management for diabetes	Behavioral: Diabetes intervention; Disease self management for diabetes; Other Names: Measurement based care; Disease self management

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Time Frame
Glycosylated Hemoglobin	week 16, 32

Secondary Outcome Measures

Outcome Measure	Time Frame
Quick Inventory of Depressive Symptoms - Self Report	week 16, 32

Collaborators and Investigators

• Sponsor: University of Texas Southwestern Medical Center
• Collaborators: National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
• Investigators: Study Director: David W. Morris, Ph.D., University of Texas Southwestern Medical Center

Study record dates

Study Major Dates

• Study Start: October 1, 2009
• Primary Completion (Actual): December 1, 2011
• Study Completion (Actual): December 1, 2011

Study Registration Dates

• First Submitted: July 13, 2009
• First Submitted That Met QC Criteria: July 13, 2009
• First Posted (Estimate): July 14, 2009

Study Record Updates

• Last Update Posted (Actual): September 2, 2020
• Last Update Submitted That Met QC Criteria: September 1, 2020
• Last Verified: September 1, 2020

More Information

Terms related to this study

• Keywords: Depression; Diabetes; Measurement Based Care; Disease Self Management
• Additional Relevant MeSH Terms: Behavioral Symptoms; Mental Disorders; Glucose Metabolism Disorders; Metabolic Diseases; Mood Disorders; Endocrine System Diseases; Depression; Depressive Disorder; Diabetes Mellitus; Depressive Disorder, Major
• Other Study ID Numbers: STU 042009-010; R34DK081031 (U.S. NIH Grant/Contract)