patient provider relationships and diabetes and depression (post midterm 2)

traditional Patient provider relationships

Traditional expert or biomedical model:

• Doctors have objective knowledge set

• Doctor communicate knowledge to passive patient 

• Patient acts on doctor’s advice 

new patient provider relationship model

• Patient experts on own experience and beliefs

• Doctors are human

Patient centered approach

Alternative to expert model:

• Patient centered approach 

• Meeting of two experts 

Patient centered approach3 components

• Doctor receptive to patient’s opinions

• Patient involved in decision making 

• Attention to emotions (patient and provider) 

Little consensus to meaning on this definition 

What do providers bring? in communication

• Doctors go in with an open mind towards patients 

• A trusting environment can bring better diagnosis. 

• Clear understanding of expectations prior to appointment. 

• Respect patient’s decisions (even if they disagree with them) 

• Get to know the person. 

• Doctors can make mistakes 

What do patients bring? in communication

• Willingness to share 

what impacts communication

• Both providers, patients, and context impact communication 

How do we improve communication?

• Training providers 

• Training patients 

• Training both

Improving communication  and Training Physician

• empathizing , education, enlisting 

• Motivational interviewing techniques 

• Recognizing and addressing communication problems 

• Coaching based audiotaped interactions 

Improving communication and training patients

• Help with planning and organizing questions 

Encourage to:

• Discuss choices 

• Negotiate best plan

• Repeat back the plan

• Ask questions

Improving communication study Haskard ET AL. 2008 (looked at above strategies) results

• Trying to improve patients communication did not work 

• Trying to improve physicians made the physicians feel stressed and rate the experience as poor 

• Trying to improve both had benefits on both sides.

Diabetes and depression risk levels

People diagnosed with type 2 diabetes had 2x higher risk of depression and type 1 diabetes had 3x higher risk of depression.

why is there a link between diabetes and depression (non-causal ones)

• Shared risk factors for both (non-causal) 

• Maybe lifestyle, genetic, dysregulation of the HPA axis 

causal relationship between diabetes and depression

• Psychological impact of managing illness?

• Depression is a risk factor for diabetes (onset and progression) ?

Psychological impact of managing illness (diabetes→ depression) reasons

Demanding self-management routines (diet, exercise, checking vitals, insulin injections)

• Heavy burden = greater risk of depression

Fear of long-term complications 

• Disease will not be concerned, can impact any part of the body, can be deadly or lead to bodily impairment. 

Physiological stress from persistent abnormalities blood glucose 

why might Physiological stress come from persistent abnormalities blood glucose 

• Greater hypoglycemia = greater risk of depression

Depression leading to diabetes reasons

Depression increases:

• Risk for type 2 diabetes 

• Complications (neuropathy, sexual dysfunction, retinopathy)

• death

Prigge et al. 2022 study

• Having depression alone increases chances of death slightly (1.2)

• Patients with just diabetes have a larger increase compared to last group (1.6)

• Diabetes and depression patients have more than just the sum of the two risks. Synergistic impact showing that depression does increase the risk of diabetes (2.25)

Why might depression lead to diabetes? onset and progression of disease

Onset 

• poor er dietary behaviors 

• Less physical activity 

• Sleep disturbances

Progression of disease 

• Poorer medical appointments attendance 

• Less interest in health management 

• Poorer glucose monitoring 

• Poorer adherence to medication 

takeaway of diabetes and depression relationship

• Take-away: each condition can exacerbate the other 

Depression and diabetes and dementia

• Decline in cognitive function severe enough to interfere with daily life 

• Depression and diabetes are independently associated with greater dementia risk (x20 with diabetes and x83 with depression) 

• Depression and diabetes have synergistic effect where having both causes a x177% of getting dementia

ACCORD-MIND study (Sullivan et al., 2013) question

Is depression associated with accelerated cognitive decline among patients with well-managed T2 diabetes?

ACCORD-MIND study (Sullivan et al., 2013) set up

• Longitudinal study 

• Time 1: measure depression, cognition, general health, medication use, age

• Patients’ cognition reassessed at 20 and 40 months 

• cognitive ability assessed 

How was cognitive ability assessed in ACCORD-MIND study

• Digit symbol subsitution test: 90 seconds: match symbols with numbers. Measure of attention and shift tasks.common intelligence task 

• Rey auditory verbal learning test: two lists of random words, repeat only words from list one. Tests memory and recall 

ACCORD-MIND study (Sullivan et al., 2013) results

• Depression = later cognitive decline (next 20 months?) better vs same vs worse (same is baseline 0)

• DSST, not depression had declined in this task. The depressed group had a significant decrease in this pattern recognition task. 

• RAVLT: not depression had increased in this task (now they know to remember list 1 the second time around). The depression group had a very tiny increase in this task. 

• Study argued evidence for depression and diabetes both increase cognitive decline.

Depression and diabetes and dementia overall

• Depression associated with cognitive decline

• Poor mental health not only increases risk of illness, but is associated with poorer outcomes after diagnosis. 

• Could improving mental health improve cognitive functioning?

Diabetes treatment and QoL

• Technological advances to manage type 1 diabetes

-Continuous subcutaneous insulin infusion (CSII)- insulin pump

-Continuous glucose monitoring 

• Do new technologies provide “better” treatment? (one thing health psychologists are focused on)

• Important to know if new technologies impact QoL 

-Reduces burden of multiple injections/blood testing?

-Discomfort and mechanical problems?

Continuous subcutaneous insulin infusion (CSII)

delivers rapid-acting insulin continuously 24 hours a day through a small portable device to manage diabetes

Diabetes and QoL Yu et a;., 2024 question

• Does QoL differ for CSII and multiple daily injections?

Diabetes and QoL Yu et a;., 2024 set up

• Individuals with type 1 diabetes (18+)

• 102 matched pairs with CSII or injections 

• Insulin theraoy related QoL assessed

Diabetes and QoL Yu et a;., 2024 results

• Evidence that CSII can increase QoL in activites of daily living, social activities, and psychological states compared to multiple daily injections 

• No difference in adverse insulin reactions though