Diabetes and Depression

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Diabetes and Depression
Online Training
CDC Diabetes Translation Conference May 7, 2008
Shanti Shanti Kaur Khalsa, PhD
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Why an online course for Diabetes and Depression?

• Online courses are an effective way to provide
  CMEs and CEUs to health care professionals who
  practice in rural and frontier areas
• Diabetes and Depression is a bridge topic between
  research and clinical practice
• Research indicates that untreated depression
  leads to worse health outcomes and greater
  medical costs
• New Mexico is a predominantly rural state with
  limited medical resources outside the metro areas

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Ratio of PCPs to patients highest in rural
counties of NM
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The Cost of Depression(next 4 slides courtesy of
Michelle Owens, PhD from the CDC Division of
Diabetes Translation)

• Depression 2x more common in people with diabetes
• Significant correlation between symptoms of
  depression and severity of diabetes complications
• Total health care expenditure for individuals
  with depression and diabetes is 4.5 times higher
  than for those without depression.
• Egede LE, Zheng D, Simpson K. Comorbid
  depression is associated with increased health
  care use and expenditures in individuals with
  diabetes. Diabetes Care 2002 25 464-470.

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Health Care, Diabetes Depression

• Patients with diabetes and depression
• Spend 5x more on medications than those who have
  diabetes but do not have depression.
• Have more visits to primary care provider.
• Are less likely to adhere
• to a behavioral protocol
• for self-management.

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Diabetes and DepressionIs there a link?

• Depression is 2x as common in people who have
  diabetes as it is in people who do not have the
  disease.
• Recent meta-analysis found association between
  depression and hyperglycemia.
• Anderson RJ, Freeland KE, Clouse RE, Lustman PJ.
  The prevalence of comorbid depression in adults
  with diabetes. Diabetes Care 2001 24 1069-1078.

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Diabetes and DepressionIs there a link?

• Improvements in depressive symptoms predicted
  improved glycemic control.
• Improvements in glycemic control correlated with
  improved depressive symptoms.

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Diabetes and DepressionIs there a link?

• Depressed adults have a 37 increased risk of
  developing type 2 diabetes.
• As diabetes complications worsen, the chances of
  becoming depressed increase.
• Kinder LS, Kamarck TW, Baum A, Orchard TJ.
  Depressive symptomatology and coronary heart
  disease in type 1 diabetes mellitus A study of
  possible mechanisms. Health Psychol 2002 21
  542-552.

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Diabetes and Depression

• So what does it take to create a course online?

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Resources

• DPCP staff
• MediaDesigns staff
• Content expert (Certified Diabetes Educator)
• Advisory group
• Physicians
• Psychiatrists
• CEU test site accreditors
• Reviewers
• Database specialist
• (amortizing costs)

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Timeline
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Results so far by state 368 users from 46
states!
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Results so far by profession
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Lessons learned

• Be clear about scope features from the outset
• Discuss all components upfront
• Ensure components will work seamlessly
• Confirm required resources
• Start applying for CEUs early
• Be prepared for a variety of CEU standards
• Work with flexible testing service
• Plan launch and marketing strategies
• Monitor and track usage

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What providers are saying

• Very good explanation of research in diabetes and
  depression.
• Very useful in my current practice thank you!
• Very informative and enjoyable way to earn
  continuing education units.
• I enjoyed it being self-paced and my being able
  to go back and review sections too.
• This was an excellent self-study course Id
  like to see more like it.
• I have a Masters degree in Health Education, but
  this information was new to me. I appreciated
  the update.
• This course was well adapted for all types of
  health professionals.

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Take the course at www.diabetesnm.org
For more information contact Anna Hargreaves
atanna.hargreaves_at_state.nm.us
National Diabetes Education Program (NDEP) has
also developed a Webpage on Diabetes and
Depression with CE credits at www.diabetesatwork
.org/DiabetesResources/DiabetesandDepression.cfm