Depression Screening and Glycated Hemoglobin Levels: Diabetes Follow-Up Measures

Diabetes and depression often co-exist. This combination may exacerbate the progression of diabetes; therefore, diagnosis and treatment of depression may improve diabetes management. In addition to routine monitoring of glycated hemoglobin (A1C) levels, diabetic patients should receive an annual depression screen to facilitate treatment and referral. Yet in the outpatient setting, depression screening is an underutilized tool. The overarching purpose of this project is to address and treat the depression in patients with diabetes, and to decrease A1C levels and ultimately improve chronic disease outcomes.

A literature review explored interventions to improve chronic disease outcomes in adults. Selected studies revealed common themes that impacted outcomes in diabetic patients and included missed appointments, elevated A1C levels with co-existing depression, and missed depression diagnosis.

This project explored outcomes associated with implementation of scheduled depression screening for patients with diabetes age 18 to 64 in an urban community internal medicine clinic. All diabetic patients were screened with the Patient Health Questionnaire-9 (PHQ-9) at follow-up appointments over a 4-week period. Demographic data and the severity of depression measured by the PHQ-9 score will provide descriptive analysis of the screened populations. Measures of central tendency and spread will also be analyzed. The measurable outcomes include the following: number of diabetic patients who were not being treated for depression at the time they completed the questionnaire, and whose responses to the PHQ-9 would support a diagnosis of depression.

Consistent screening will support treatment and referral of diabetic patients whose PHQ-9 result indicates depression. This cost-effective intervention may reduce complications of diabetes, and help patients manage their A1C levels.

At community internal medicine practices internationally, there is room for improvement in diabetes follow-up care. Additional monitoring strategies may lessen emergency department visits and hospital readmission for all patients with diabetes. The goal is to identify these high-risk patients, screen for depression, and ensure follow-up care. Given the minimal effort and cost of depression screening, outpatient clinics internationally may consider routinely screening patients with diabetes for depression.