Mental health coaching improves outcomes for people with diabetes, depression

A significant number of people with diabetes suffer from depression, which can interfere with their ability to participate in self-care activities such as monitoring, being active, eating healthy and taking medication. These self-care activities are key to managing the chronic, progressive disease.

Diabetes educators developed a program to identify and provide resources for depression among people with diabetes in central North Carolina, an area where nearly 16 percent of the population has diabetes (vs. 10 percent nationally): 30 percent of them have depression and 65 percent live below the poverty level. Patients with newly diagnosed diabetes were referred to a diabetes educator, and those who were identified as also having depression received mental health coaching as well.

In the pilot, 182 patients with Type 2 diabetes received mental health coaching, including an average of three visits in which the coach helped them find tools to best address the stressors and challenges in their lives. The mental health coach used the Patient Health Questionnaire (PHQ9) to measure anxiety and depression scores prior to and after intervention, and scores decreased by 49 percent on average after three months. Further, A1C levels decreased from 8.8 percent to 7.7 percent on average. A1C measures the concentration of glucose (sugar) in the blood, a reflection of how well the diabetes is being controlled. People with diabetes strive to get their A1C levels below 7 percent, which can be challenging.

"The program was to be piloted for a two year period but has been so powerful, we have continued it," said Melissa Herman, RD, certified diabetes educator and program director of the Diabetes & Nutrition Education Center of FirstHealth of the Carolinas, Pinehurst, N.C. "While healthy coping is an essential part of diabetes education, mental health coaching takes it to another level for people who struggle with depression. Those who had mental health coaching said it was life-changing, life-saving and helped them feel better and happier than they had in a long time."

All patients also received diabetes education to help them learn how to manage their disease and be as healthy as possible by focusing on the AADE7TM Self-Care Behaviors: healthy eating, being active, monitoring, taking medication, problem solving, healthy coping and reducing risks.

More than 29 million Americans -- nearly one in 10 -- have diabetes, a disorder in which the body doesn't effectively process glucose, which provides the body fuel for energy and growth. In Type 1 diabetes, the body doesn't produce insulin, which processes glucose. In Type 2 diabetes, the body doesn't produce enough insulin, or doesn't react properly to the insulin it does produce. More than 90 percent of people with diabetes have Type 2. If diabetes isn't treated, it can lead to serious health issues such as heart disease, blindness and kidney problems. Diabetes can't be cured, but can be managed with medication and lifestyle changes.