From left, researchers Kerry Littlewood, Lesley Lutes, Kari Kirian and Doyle Cummings hope to help black women with diabetes better manage depression and distress. Photo by Cliff Hollis
Grant to help those with diabetes, depression
By Doug Boyd
ECU News Services
(Nov. 25, 2013)
East Carolina University has received a grant of $450,000 to help people with type 2 diabetes and related depression or distress manage their illnesses.
According to ECU researchers, more than half of their patients with type 2 diabetes also suffer from related behavioral conditions including depression and distress. Those conditions are often undiagnosed and untreated.
In an earlier diabetes trial involving 200 African-American women with uncontrolled Type 2 diabetes mellitus, ECU researchers found 40 percent feel distress about their illness, 56 percent have increased distress about managing their illness, 20 percent have depressive symptoms, and 60 percent don't use their medication as prescribed, possibly as a result of distress or depression.
To address the diabetes-related behavioral conditions, ECU researchers, along with community partners in rural eastern North Carolina, will combine medical and cognitive behavioral treatment with community-based support to assist patients.
"These patients are much more likely to end up in the emergency department, and it's been shown that they are dying earlier," said Dr. Lesley Lutes, an associate professor, director of clinical training in the ECU Department of Psychology and one of the researchers leading the project. "Even though diabetes itself is very serious, these other chronic conditions make its impact on patient health much worse."
The project will use a care manager linked to medical, pharmacologic and behavioral colleagues. The community component will also use community health workers to provide support and improve access to resources.
Researchers plan to make the interventions culturally relevant in trusted primary care and community settings. Partners will include the health system, health departments, churches, federally qualified health centers and people with type 2 diabetes.
In addition to Lutes, ECU researchers involved in the project are Dr. Doyle Cummings, a pharmacist and professor of family medicine; Dr. Kerry Littlewood, an assistant professor of social work; and Dr. Kari Kirian, a health psychologist and assistant professor of family medicine.
People with diabetes often have other conditions, such as high blood pressure and high cholesterol, along with medications and doctor's appointments for those conditions.
"At a certain point, it becomes overwhelming," Lutes said.
Researchers will measure the success of the project, estimate its financial impact and build a sustainable business model for replication.
The U.S. Centers for Disease Control and Prevention estimates that one in 10 black women age 20 and older has diabetes, and the rate might be higher in eastern North Carolina, Cummings said. After age 55, the rate more than doubles to one in four. Blacks also suffer high rates of diabetes' most serious complications, such as blindness, kidney failure and amputation.
ECU was one of four recipients nationwide to share in $1.8 million in grants from the Bristol-Myers Squibb Foundation in this grant cycle. The grants are part of Bristol-Myers' five-year, $100 million "Together on Diabetes" project to improve health outcomes of people living with type 2 diabetes in the United States by strengthening patient self-management education, community-based supportive services and broad-based community mobilization.
The University of Michigan, University of Colorado and Health Choice Network of Florida also received grants in this cycle.
This grant is ECU's second in the Together on Diabetes project. Two years, ago, Lutes, Cummings and Littlewood received $300,000 to implement a "small changes" approach to help black women with type 2 diabetes improve their health and better manage their disease through the use of community health workers to deliver the treatment program. The project, still underway, hopes to demonstrate community support and interaction helped women manage their diabetes better than educational materials alone.
This summer, Cummings and Dr. Dennis Russo, a psychologist and clinical professor of family medicine, received more than $1 million in grants from other agencies to develop a program that will support collaborative diabetes care in rural areas via telemedicine. In that project, secure two-way audio and video links will connect experts at ECU to seven rural primary care sites.
Together on Diabetes is a five-year, $115 million project launched in 2010 by the Bristol-Myers Squibb Foundation to improve health outcomes of people living with type 2 diabetes in China, India and the United States by strengthening patient self-management education, community-based supportive services and broad-based community mobilization. More information is online at http://TogetherOnDiabetes.com
To date, the United States program has committed $53 million to 25 grantees working in 60 communities across the country, and the China-India program has committed $4.4 million to 9 grantees with strong networks to reach, educate, serve and mobilize heavily affected communities. China, India and the United States have the most people living with diabetes.
The Bristol-Myers Squibb Foundation is an independent charitable organization whose mission is to reduce health disparities and improve health outcomes around the world for patients disproportionately affected by serious disease.
November is American Diabetes Month.