MedStar Health Researchers Examine Feasibility of a Telemedicine-Enabled Mental Health Intervention for Adults With Type 2 Diabetes

Collaborative research from MedStar Diabetes Institute, MedStar Health Research Institute, and the Georgetown University Department of Psychiatry examined the feasibility of co-delivering a mental health intervention with an evidence-based type 2 diabetes (T2DM) boot camp care management program. The research team also examined the preliminary impact of participation on symptom scores for depression and anxiety and A1C.

In the United States, over half of the adults living with type 2 diabetes mellitus have at least 1 other chronic physical or mental health condition. Depression is one of the most prevalent comorbities of type 2 diabetes. To improve type 2 diabetes outcomes, it is important to diagnose and treat both diabetes and depression/anxiety when patients present with both.

The study was a 12-week pilot intervention with African American adults with uncontrolled type 2 diabetes and moderate depression and/or anxiety, who were participating in an existing Diabetes Boot Camp program. The participants were then enrolled in the diabetes and mental health co-management (DM-MH) pilot study. This program was offered via a combination of 2 initial on-site visits and subsequent remote telehealth visits using telephone, text, or email. The mental health intervention component involved 6 structured sessions with a mental health interventionist, who was also trained to recognize worsening mental health symptoms, identify and evaluate safety concerns, seek consultation, and make appropriate referrals. The structured mental health component targeted depression and/or anxiety symptoms based on the PHQ-9 and GAD-7 baseline scores. Participants were assessed at baseline and 90 days.

The study results showed significant improvements in mental health outcomes, as measured by a reduction in Patient Health Questionnaire − 9 scores of 2.4 ± 2.9 (P = .01) and in Generalized Anxiety Disorder − 7 scores of 2.3 ± 1.9 (P = .001). The pre-post intervention mean A1C improved by 3.4 ± 2.1units from 12% ± 1.4% to 8.5% ± 1.7% (P < .001).

The study team concluded that the data supports the feasibility of delivering a diabetes and mental health co-management intervention using a combination of in-person and telemedicine visits to engage adults with T2DM and coexisting moderate depression and/or anxiety. Further research with a control group and a larger sample size could show potential in improving glycemic and mental health outcomes in patients with T2DM via co-management of their T2DM and moderate anxiety and/or depression.

The research team included Michelle F. Magee, MD, MBBCh, BAO, LRCPSI from MedStar Diabetes Institute, MedStar Health Research Institute, and the Georgetown University School of Medicine; Carine M. Nassar, RD, MS from MedStar Diabetes Institute and MedStar Health Research Institute; Mihriye Mete from MedStar Health Research Institute and Georgetown University Department of Psychiatry; and Stacey I. Kaltman, PhD from Georgetown University Department of Psychiatry.

Funding for the study was provided by an intramural grant from the MedStar Health Research Institute.