Addressing the needs of patients with multiple chronic illnesses: the case of diabetes and depression.

OBJECTIVES To review the literature on comorbid depression and diabetes (DM/D) and present a conceptual framework for integrating depression management with diabetes care in a managed care environment. STUDY DESIGN Literature review. RESULTS Depression affects diabetes management by 1) directly affecting patients' health-related quality of life, 2) reducing physical activity levels, 3) limiting adherence to self-care regimens, and 4) impairing patients' ability to communicate effectively with clinicians. Small randomized trials suggest that both antidepressant medication and cognitive behavioral therapies (CBTs) or related approaches may improve not only DM/D patients' depressive symptoms, but their physical health as well. CONCLUSIONS An effective DM/D management strategy should include the following elements: 1) systematic identification of DM/D patients and quality-of-care reviews, 2) proactive patient monitoring between outpatient encounters, 3) intensive efforts to coordinate treatment across providers, 4) increased access to CBT or related therapies addressing patients' depressive symptoms and diabetes self care, and 5) an emphasis on promoting physical activity to address both depressive symptoms and physiologic dysregulation. The conceptual framework developed for the care of DM/D patients offers general insights into the management of patients with multiple chronic medical disorders

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