TY - JOUR
AU - S. J. Shimu
AU - S. Akter
AU - M. M. Rahman
AU - S. Arbee
AU - M. S. Mohiuddin
AU - S. Sazzad
AU - M. Raiqa
AU - M. M. Mohib
AU - A. R. Munmun
AU - M. B. Uddin
A1 - 
AB - Background: Diabetes and mental health conditions frequently co-occur, with depression and anxiety affecting up to 20-30% of people with diabetes. These comorbidities worsen glycemic control, adherence, and quality of life, yet mental health is often neglected in diabetes care. Integrating mental health services into diabetes management is recommended by international organizations to improve patient outcomes. Objectives: To systematically review the evidence on integrated mental health interventions in diabetes care, compared to usual diabetes care, in improving patient outcomes (glycemic control, mental health, adherence, quality of life). Methods: We searched PubMed/MEDLINE, Embase, PsycINFO, and Scopus (2000 through July 2024) for studies of diabetes care integrating mental health support (e.g., collaborative care, co-location, stepped care, or digital interventions). Inclusion criteria were controlled trials or cohort studies involving individuals with type 1 or type 2 diabetes receiving an integrated mental health intervention, with outcomes on glycemic control and/or mental health. Two reviewers independently screened titles/abstracts and full texts, with disagreements resolved by consensus. Data on study design, population, intervention components, and outcomes were extracted. Risk of bias was assessed using Cochrane or appropriate tools. Results: Out of records identified, 64 studies met inclusion criteria (primarily randomized controlled trials). Integrated care models consistently improved depression and anxiety outcomes and diabetes-specific distress, and yielded modest but significant reductions in glycated hemoglobin (HbA1c) compared to usual care. Many interventions also enhanced treatment adherence and self-management behaviors. For example, collaborative care trials showed greater depression remission rates and small HbA1c improvements (~0.3-0.5% absolute reduction) relative to standard care. Co-located care in diabetes clinics was associated with reduced diabetes distress, depression scores, and HbA1c over 12 months. Digital health integrations (telepsychiatry, online cognitive-behavioral therapy) improved psychological outcomes and adherence, with some reporting slight improvements in glycemic control. Integrated approaches often increased uptake of mental health services (e.g., higher referral completion rates) and showed high patient satisfaction. A subset of studies reported fewer emergency visits and hospitalizations with integrated care, and one economic analysis found collaborative care cost-effective in primary care settings. Conclusions: Integrating mental health into diabetes care leads to better mental health outcomes and modest improvements in glycemic control, without adverse effects. Heterogeneity across studies is noted, but the overall evidence supports multidisciplinary, patient-centered care models to address the psychosocial needs of people with diabetes. Healthcare systems should prioritize implementing and scaling integrated care, accompanied by provider training and policy support, to improve outcomes and bridge the persistent treatment gap. Future research should focus on long-term effectiveness, cost-effectiveness, and strategies to reach diverse populations.
AD - Department of Health Informatics, Harrisburg University of Science and Technology, Harrisburg, PA 17101, USA.; Department of Endocrinology, Diabetes & Metabolism, Jacobs School of Medicine and Biomedical Sciences, The State University of New York, 705 Maple Road, Williamsville, NY 14221, USA.; Indiana College of Graduate and Professional Studies, Trine University, One University Avenue, Angola, IN 46703, USA.; Institute for Molecular Medicine, Aichi Medical University, 1-Yazako, Karimata, Nagakute 480-1103, Aichi, Japan.; Department of Foundations of Medicine, NYU Grossman Long Island School of Medicine, 101 Mineola Blvd, Mineola, NY 11501, USA.; Department of Biomedical Engineering and Informatics, Luddy School of Informatics, Computing and Engineering, Indiana University Indianapolis, 420 University Blvd, Indianapolis, IN 46202, USA.; Department of Neuroscience, Stony Brook University, 101 Nicolls Road, Stony Brook, NY 11794, USA.; Department of Pharmaceutical Sciences, North South University, Dhaka 1229, Bangladesh.; Julius Bernstein Institute of Physiology, Medical School, Martin Luther University of Halle-Wittenberg, Mag-deburger Straße 6, 06112 Halle, Germany.; Department of Food, Bioprocessing and Nutrition Sciences, North Carolina State University, Raleigh, NC 27695, USA.
AN - 41283260
BT - Med Sci (Basel)
C5 - Healthcare Disparities
CP - 4
DA - Nov 3
DO - 10.3390/medsci13040259
DP - NLM
ET - 20251103
IS - 4
JF - Med Sci (Basel)
LA - eng
N2 - Background: Diabetes and mental health conditions frequently co-occur, with depression and anxiety affecting up to 20-30% of people with diabetes. These comorbidities worsen glycemic control, adherence, and quality of life, yet mental health is often neglected in diabetes care. Integrating mental health services into diabetes management is recommended by international organizations to improve patient outcomes. Objectives: To systematically review the evidence on integrated mental health interventions in diabetes care, compared to usual diabetes care, in improving patient outcomes (glycemic control, mental health, adherence, quality of life). Methods: We searched PubMed/MEDLINE, Embase, PsycINFO, and Scopus (2000 through July 2024) for studies of diabetes care integrating mental health support (e.g., collaborative care, co-location, stepped care, or digital interventions). Inclusion criteria were controlled trials or cohort studies involving individuals with type 1 or type 2 diabetes receiving an integrated mental health intervention, with outcomes on glycemic control and/or mental health. Two reviewers independently screened titles/abstracts and full texts, with disagreements resolved by consensus. Data on study design, population, intervention components, and outcomes were extracted. Risk of bias was assessed using Cochrane or appropriate tools. Results: Out of records identified, 64 studies met inclusion criteria (primarily randomized controlled trials). Integrated care models consistently improved depression and anxiety outcomes and diabetes-specific distress, and yielded modest but significant reductions in glycated hemoglobin (HbA1c) compared to usual care. Many interventions also enhanced treatment adherence and self-management behaviors. For example, collaborative care trials showed greater depression remission rates and small HbA1c improvements (~0.3-0.5% absolute reduction) relative to standard care. Co-located care in diabetes clinics was associated with reduced diabetes distress, depression scores, and HbA1c over 12 months. Digital health integrations (telepsychiatry, online cognitive-behavioral therapy) improved psychological outcomes and adherence, with some reporting slight improvements in glycemic control. Integrated approaches often increased uptake of mental health services (e.g., higher referral completion rates) and showed high patient satisfaction. A subset of studies reported fewer emergency visits and hospitalizations with integrated care, and one economic analysis found collaborative care cost-effective in primary care settings. Conclusions: Integrating mental health into diabetes care leads to better mental health outcomes and modest improvements in glycemic control, without adverse effects. Heterogeneity across studies is noted, but the overall evidence supports multidisciplinary, patient-centered care models to address the psychosocial needs of people with diabetes. Healthcare systems should prioritize implementing and scaling integrated care, accompanied by provider training and policy support, to improve outcomes and bridge the persistent treatment gap. Future research should focus on long-term effectiveness, cost-effectiveness, and strategies to reach diverse populations.
PY - 2025
SN - 2076-3271
ST - Integrating Mental Health into Diabetes Care: Closing the Treatment Gap for Better Outcomes-A Systematic Review
T1 - Integrating Mental Health into Diabetes Care: Closing the Treatment Gap for Better Outcomes-A Systematic Review
T2 - Med Sci (Basel)
TI - Integrating Mental Health into Diabetes Care: Closing the Treatment Gap for Better Outcomes-A Systematic Review
U1 - Healthcare Disparities
U3 - 10.3390/medsci13040259
VL - 13
VO - 2076-3271
Y1 - 2025
ER -