Type 2 diabetes mellitus is a chief concern for patients, healthcare providers, and health care systems in America, and around the globe. Individuals with type 2 diabetes mellitus exhibit clinical and subclinical symptoms of anxiety more frequently than people without diabetes. Anxiety is traditionally associated with poor metabolic outcomes and increased medical complications among those with type 2 diabetes mellitus. Collaborative care models have been utilized in the multidisciplinary treatment of mental health problems and chronic disease, and have demonstrated success in managing the pathology of depression which often accompanies diabetes. However, no specific treatment model has been published that links the treatment of anxiety to the treatment of type 2 diabetes mellitus. Given the success of collaborative care models in treating depression associated with diabetes, and anxiety unrelated to chronic disease, it is possible that the collaborative care treatment of primary care patients who suffer from both anxiety and diabetes could be met with the same success. The key issue is determining how to implement and sustain these models in practice. This review summarizes the proposed link between anxiety and diabetes, and offers an innovative and evidence-based collaborative care model for anxiety and diabetes in primary care.
Centers for Disease Control and Prevention. National diabetes fact sheet: national estimates and general information on diabetes and pre-diabetes in the United States, 2011, Atlanta, GA: U.S. Department of Health and Human Services, 2011.
2.
American Diabetes Association (ADA). Standards of medical care in diabetes. Diabetes Care2011; 34: S11–61.
3.
Centers for Disease Control and Prevention. Diabetes report card 2012, Atlanta, GA: Centers for Disease Control and Prevention, US Department of Health and Human Services, 2012.
4.
Centers for Disease Control and Prevention. Collaborative practice agreements and pharmacists’ patient care services: a resource for doctors, nurses, physician assistants, and other providers, Atlanta, GA: US Department of Health and Human Services, 2013.
5.
CollinsMMCorcoranPPerryIJ. Anxiety and depression symptoms in patients with diabetes. Diabet Med2009; 26: 153–61.
6.
GrigsbyABAndersonRJFreedlandKEClouseRELustmanPJ. Prevalence of anxiety in adults with diabetes: a systematic review. J Psychosom Res2002; 53: 1053–60.
7.
KhuwajaAKLalaniSDhananiRAzamISRafiqueGWhiteF. Anxiety and depression among outpatients with type 2 diabetes: a multi-centre study of prevalence and associated factors. Diabetol Metabol Syndr2010; 2: 72–72.
8.
SmithKJBelandMClydeMGariepyGPageVBadawiGRabasa-LhoretRSchmitzN. Association of diabetes with anxiety: a systematic review and meta-analysis. J Psychosom Res2013; 74: 89–99.
9.
ThomasJJonesGScarinciIBrantleyP. A descriptive and comparative study of the prevalence of depressive and anxiety disorders in low-income adults with type 2 diabetes and other chronic illnesses. Diabetes Care2003; 26: 2311–7.
10.
BrielerJALustmanPJScherrerJFSalasJSchneiderFD. Antidepressant medication use and glycaemic control in co-morbid type 2 diabetes and depression. Fam Pract2016; 33: 30–6.
11.
KatonWJYoungBARussoJLinEHCiechanowskiPLudmanEJVon KorffMR. Association of depression with increased risk of severe hypoglycemic episodes in patients with diabetes. Ann Fam Med2013; 11: 245–50.
12.
de GrootMAndersonRFreedlandKEClouseRELustmanPJ. Association of depression and diabetes complications: a meta-analysis. Psychosom Med2001; 63: 619–30.
13.
KinderLSKamarckTWBaumAOrchardTJ. Depressive symptomatology and coronary heart disease in Type I diabetes mellitus: a study of possible mechanisms. Health Psychol2002; 21: 542–52.
14.
de GrootMPinkermanBWagnerJHockmanE. Depression treatment and satisfaction in a multicultural sample of type 1 and type 2 diabetic patients. Diabetes Care2006; 29: 549–53.
15.
EgedeLEZhengDSimpsonK. Comorbid depression is associated with increased health care use and expenditures in individuals with diabetes. Diabetes Care2002; 25: 464–70.
16.
Lang PJ. Fear reduction and fear behavior: Problems in treating a construct. In: Schlien JM (ed) Research in Psychotherapy, Vol. 3. Washington, DC: American Psychological Association, 1968, pp. 90–103.
17.
StanleyR. Anxiety and its disorders – the nature and treatment of anxiety and panic, New York: The Guilford Press, 2002.
18.
KroenkeKSpitzerRLWilliamsJB. Anxiety disorders in primary care: prevalence, impairment, comorbidity, and detection. Ann Intern Med2007; 146: 317–25.
19.
Kessler R. National Comorbidity Survey: Reinterview (NCS-2), 2001-2002. ICPSR35067-v2. Ann Arbor, MI: Inter-university Consortium for Political and Social Research [distributor], http://doi.org/10.3886/ICPSR35067.v2 (accessed 13 January 2015).
20.
Tovilla-ZárateCJuárez-RojopIPeralta JimenezYJiménezMAVázquezSBermúdez-OcañaDRamón-FríasTGenis MendozaADGarcíaSPNarváezLL. Prevalence of anxiety and depression among outpatients with type 2 diabetes in the Mexican population. PloS One2012; 7: e36887–e36887.
21.
LiCBarkerLFordESZhangXStrineTWMokdadAH. Diabetes and anxiety in US adults: findings from the 2006 behavioral risk factor surveillance system. Diabet Med2008; 25: 878–81.
22.
AndersonRJGrigsbyABFreedlandKEde GrootMMcGillJBClouseRELustmanPJ. Anxiety and poor glycemic control: a meta-analytic review of the literature. Int J Psychiatry Med2002; 32: 235–47.
23.
KesslerRCChiuWTDemlerOMerikangasKRWaltersEE. Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry2005; 62: 617–27.
24.
SpitzerRLKroenkeKLinzerMHahnSRWilliamsJBdeGruyFVBrodyDDaviesM. Health-related quality of life in primary care patients with mental disorders. Results from the PRIME-MD 1000 Study. JAMA1995; 274: 1511–7.
25.
MendlowiczMVSteinMB. Quality of life in individuals with anxiety disorders. AM J Psychiatry2000; 157: 669–82.
26.
FiferSKMathiasSDPatrickDLMazonsonPDLubeckDPBueschingDP. Untreated anxiety among adult primary care patients in a health maintenance organization. Arch Gen Psychiatry1994; 51: 740–50.
27.
OrmelJvan den BrinkWvan der MeerKJennerJGielR. [Prevalence, indication and course of depression in family practice]. Ned Tijdschr Geneeskd1994; 138: 123–6.
28.
SchonfeldWHVerboncoeurCJFiferSKLipschutzRCLubeckDPBueschingDP. The functioning and well-being of patients with unrecognized anxiety disorders and major depressive disorder. J Affect Disord1997; 43: 105–19.
29.
de BeursEBeekmanATvan BalkomAJDeegDJvan DyckRvan TilburgW. Consequences of anxiety in older persons: its effect on disability, well-being and use of health services. Psychol Med1999; 29: 583–93.
30.
KatonWVon KorffMLinELipscombPRussoJWagnerEPolkE. Distressed high utilizers of medical care. DSM-III-R diagnoses and treatment needs. Gen Hosp Psychiatry1990; 12: 355–62.
31.
KennedyBLSchwabJJ. Utilization of medical specialists by anxiety disorder patients. Psychosomatics1997; 38: 109–12.
32.
SteinBCLevinRI. Natriuretic peptides: physiology, therapeutic potential, and risk stratification in ischemic heart disease. Am Heart J1998; 135(5 Pt 1): 914–23.
33.
ChampaneriSWandGSMalhotraSSCasagrandeSSGoldenSH. Biological basis of depression in adults with diabetes. Curr Diab Rep2010; 10: 396–405.
34.
KischES. Stressful events and the onset of diabetes mellitus. Israel J Med Sci1985; 21: 356–8.
35.
KawakamiNArakiSTakatsukaNShimizuHIshibashiH. Overtime, psychosocial working conditions, and occurrence of non-insulin dependent diabetes mellitus in Japanese men. J Epidemiol Commun Health1999; 53: 359–63.
36.
KawakamiNTakatsukaNShimizuHIshibashiH. Depressive symptoms and occurrence of type 2 diabetes among Japanese men. Diabetes Care1999; 22: 1071–6.
37.
VialettesBOzanonJPKaplanskySFarnarierCSauvagetELassmann-VagueVBernardDVagueP. Stress antecedents and immune status in recently diagnosed type I (insulindependent) diabetes mellitus. Diabete Metab1989; 15: 45–50.
38.
MaesSLeventhalHRidderDTDCoping with chronic diseases. In: ZeidnerMEndlerN (eds). Handbook of coping: theory, research and applications, New York: Wiley, 1996.
39.
LazarusRSFolkmanS. Stress, appraisal, and coping, New York: Springer, 1984.
40.
AlbertiG. The dawn (diabetes attitudes, wishes and needs) study. Pract Diab Int2002; 19: 22–4.
41.
CherringtonAAyalaGXSleathBCorbie-SmithG. Examining knowledge, attitudes, and beliefs about depression among Latino adults with type 2 diabetes. Diabetes Educ2006; 32: 603–13.
42.
DelahantyLM1GrantRWWittenbergEBoschJLWexlerDJCaglieroEMeigsJB. Association of diabetes-related emotional distress with diabetes treatment in primary care patients with Type 2 diabetes. Diabet Med2007; 24: 48–54.
43.
drumDZierenbergT. Type II diabetes source book, 3rd ed. USA: McGraw-Hill Companies, 2005.
44.
MandersonLKokanovicR. “Worried all the time'”: distress and the circumstances of everyday life among immigrant Australians with type 2 diabetes. Chronic Illn2009; 5: 21–32.
45.
PenckoferSFerransCEVelsor-FriedrichBSavoyS. The psychological impact of living with diabetes: women's day-to-day experiences. Diabetes Educ2007; 33: 680–90.
PouwerF. Should we screen for emotional distress in type 2 diabetes mellitus?Nat Rev Endocrinol2009; 5: 665–71.
48.
PolonskyWH1AndersonBJLohrerPAWelchGJacobsonAMAponteJESchwartzCE. Assessment of diabetes-related distress. Diabetes Care1995; 18: 754–60.
49.
CiechanowskiPSKatonWJRussoJE. Depression and diabetes: impact of depressive symptoms on adherence, function, and costs. Arch Intern Med2000; 160: 3278–85.
50.
SurwitRSSchneiderMSFeinglosMN. Stress and diabetes mellitus. Diabetes Care1992; 15: 1413–22.
51.
PeyrotMMcMurryJFJrKrugerDF. A biopsychosocial model of glycemic control in diabetes: stress, coping and regimen adherence. J Health Soc Behav1999; 40: 141–58.
52.
BrennanCHarkinsVPerryIJ. Management of diabetes in primary care: a structured-care approach. Eur J Gen Pract2008; 14: 117–22.
53.
Orozco-BeltranDPanCSvendsenAFaerchLCaputoS. Basal insulin initiation in primary vs. specialist care: similar glycaemic control in two different patient populations. Int J Clin Pract2016; 70: 236–43.
54.
ArcherJBowerPGilbodySLovellKRichardsDGaskLDickensCCoventryP. Collaborative care for depression and anxiety problems. Cochrane Database Syst Rev2012; 10: CD006525.–CD006525..
55.
PrinsMAVerhaakPFHilbink-SmoldersMSpreeuwenbergPLaurantMGvan der MeerKvan MarwijkHPenninxBBensingalJM. Outcomes for depression and anxiety in primary care and details of treatment: a naturalistic longitudinal study. BMC Psychiatry2011; 11: 180–180.
56.
DohertyWJMcDanielSHBairdMA. Five levels of primary care/behavioral healthcare collaboration. Behav Healthcare Tom1996; 5: 25–7.
57.
PincusHAHoughLHoutsingerJKRollmanBLFrankRG. Emerging models of depression care: multi-level (‘6 P') strategies. Int J Meth Psychiat Res2003; 12: 54–63.
VandenBosGDeLeonP. The use of psychotherapy to improve physical health. PsychotherTheory Res Pract Train1998; 25: 335–43.
61.
Cummings NA. Behavioral health in primary care: dollars and sense. In: Cummings NA, Johnston JN, Cummings J (eds). Behavioral health in primary care: a guide for clinical integration. Madison, CT: Psychosocial Press, 1997, pp. 3–21.
62.
O’DonohueWTCummingsNAFergusonKEClinical integration: the promise and the path. In: CummingsNAO’DonohueWTFergusonKE (eds). Behavioral health as primary care: beyond efficacy to effectiveness, Reno, NV: Context, 2003, pp. 15–30.
63.
Hornik-LurieTLernerYZilberNFeinsonMCCwikelJG. Physicians' influence on primary care patients' reluctance to use mental health treatment. Psychiatr Serv2014; 65: 541–5.
64.
CwikelJZilberNFeinsonMLernerY. Prevalence and risk factors of threshold and sub-threshold psychiatric disorders in primary care. Soc Psychiatry Psychiatr Epidemiol2008; 43: 184–91.
65.
CunninghamPJ. Beyond parity: a primary care physicians’ perspectives on access to mental health care. Health Affairs2009; 26: 153–61.
66.
KesslerRStaffordDMessierR. The problem of integrating behavioral health in the medical home and the questions it leads to. J Clin Psychol Med Settings2009; 16: 4–12.
67.
HarknessEMacdonaldWValderasJCoventryPGaskLBowerP. Identifying psychosocial interventions that improve both physical and mental health in patients with diabetes: a systematic review and meta-analysis. Diabetes Care2010; 33: 926–30.
68.
ColemanJVPatrickDL. Integrating mental health services into primary medical care. Med Care1976; 14: 654–61.
69.
LandisSEBarrettMGalvinSL. Effects of different models of integrated collaborative care in a family medicine residency program. Fam Syst Health2013; 31: 264–73.
70.
Curtis R, Christian E. (eds). Integrated care: applying theory to practice. New York: Routledge, 2012.
71.
Hunter C, Goodie J, Oordt M. Integrated behavioral health in primary care: Step-by-step guidance for assessment and intervention. Washington, DC: American Psychological Association, 2009.
72.
RobinsonPJReiterJT. Behavioural consultation and primary care: a guide to integrting services, New York: Springer, 2007.
73.
Collins C, Hewson DL, Munger R, Wade T. Evolving models of behavioral health integration in primary care. New York: Milbank Memorial Fund, 2010.
74.
OlfsonMSingMSlesingerHJ. Mental health/medical cost care offsets: opportunities for managed care. Health Affairs1999; 18: 79–93.
75.
SimonGEKatonWJLinEHRutterCManningWGVon KorffMCiechanowskiPLudmanEJYoungBA. Cost-effectiveness of systematic depression treatment among people with diabetes mellitus. Arch Gen Psychiatry2007; 64: 65–72.
76.
SimonGEKatonWJVonKorffMUnützerJLinEHWalkerEABushTRutterCLudmanE. Cost-effectiveness of a collaborative care program for primary care patients with persistent depression. Am J Psychiatry2001; 158: 1638–44.
77.
SimonGWagnerEVonkorffM. Cost-effectiveness comparisons using “real world” randomized trials: the case of new antidepressant drugs. J Clin Epidemiol1995; 48: 363–73.
78.
BegleyCEHickeyJSOstermeyerBTeskeLAVuTWolfJKunikMERowanPJ. Integrating behavioral health and primary care: the Harris County Community Behavioral Health Program. Psychiatr Serv2008; 59: 356–8.
79.
BalestrieriMWilliamsPWilkinsonG. Specialist mental health treatment in general practice: a meta-analysis. Psychol Med1988; 18: 711–7.
80.
BerwickDMNolanTWWhittingtonJ. The triple aim: care, health, and cost. Health Affairs2008; 27: 759–69.
81.
MillerBFMendenhallTJMalikAD. Integrated primary care: an inclusive three-world view through process metrics and empirical discrimination. J Clin Psychol Med Settings2009; 16: 21–30.
82.
BognerHRMoralesKHde VriesHFCappolaAR. Integrated management of type 2 diabetes mellitus and depression treatment to improve medication adherence: a randomized controlled trial. Ann Fam Med2012; 10: 15–22.
83.
CiechanowskiPS1RussoJEKatonWJVon KorffMSimonGELinEHLudmanEJYoungBA. The association of patient relationship style and outcomes in collaborative care treatment for depression in patients with diabetes. Med Care2006; 44: 283–91.
84.
KatonW1LinEHVon KorffMCiechanowskiPLudmanEYoungBRutterCOliverMMcGregorM. Integrating depression and chronic disease care among patients with diabetes and/or coronary heart disease: the design of the TEAMcare study. Contemp Clin Trials2010; 31: 312–22.
85.
KatonW1Von KorffMLinESimonGLudmanEBushTWalkerECiechanowskiPRutterC. Improving primary care treatment of depression among patients with diabetes mellitus: the design of the pathways study. Gen Hosp Psychiatry2003; 25: 158–68.
86.
KinderLSKatonWJLudmanERussoJSimonGLinEHCiechanowskiPVon KorffMYoungB. Improving depression care in patients with diabetes and multiple complications. J Gen Intern Med2006; 21: 1036–41.
87.
WilliamsJWKatonWLinEHNöelPHWorchelJCornellJHarpoleLFultzBAHunkelerEMikaVSUnützerJ. IMPACT Investigators. The effectiveness of depression care management on diabetes-related outcomes in older patients. Ann Intern Med2004; 140: 1015–24.
88.
KatonWJVon KorffMLinEHSimonGLudmanERussoJCiechanowskiPWalkerEBushT. The pathways study: a randomized trial of collaborative care in patients with diabetes and depression. Arch Gen Psychiatry2004; 61: 1042–9.
89.
Agius M, Murphy CL, Zaman R. Does shared care help in the treatment of depression? Psychiatr Danub 2010;(22 Suppl 1):S18–22.
90.
EllKKatonWXieBLeePJKapetanovicSGutermanJChouCP. Collaborative care management of major depression among low-income, predominantly Hispanic subjects with diabetes: a randomized controlled trial. Diabetes Care2010; 33: 706–13.
91.
GaskLLudmanESchaeferJ. Qualitative study of an intervention for depression among patients with diabetes: how can we optimize patient-professional interaction?Chronic Illn2006; 2: 231–42.
92.
HuangYWeiXWuTChenRGuoA. Collaborative care for patients with depression and diabetes mellitus: a systematic review and meta-analysis. BMC Psychiatry2013; 13: 260–260.
93.
Whittemore R, Liberti LS, Jeon S, Chao A, Minges KE, Murphy K, Grey M. Efficacy and implementation of an Internet psychoeducational program for teens with type 1 diabetes. Pediat Diabetes 2015;22:22.
94.
BognerHRMoralesKHPostEPBruceML. Diabetes, depression, and death: a randomized controlled trial of a depression treatment program for older adults based in primary care (PROSPECT). Diabetes Care2007; 30: 3005–10.
95.
WayneNPerezDFKaplanDMRitvoP. Health coaching reduces HbA1c in type 2 diabetic patients from a lower-socioeconomic status community: a randomized controlled trial. J Med Intt Res2015; 17: e224–e224.
96.
SoroccoKHBratkovichKLWingoRQureshiSMMasonPJ. (Integrating care coordination home telehealth and home based primary care in rural Oklahoma: a pilot study. Psychol Serv2013; 10: 350–3.
97.
HirschfeldRMA. The comorbidity of major depression and anxiety disorders: recognition and management in primary care. Prim Care Comp J Clin Psychiatry2001; 3: 244–54.
98.
NICE Guidelines. Manchester, UK: National Institute for Health and Care Excellence. Generalized anxiety disorder and panic disorder (with or without agoraphobia) in adults: Management in primary, secondary and community care 2011, www.nice.org.uk/guidance/cg113/chapter/guidance. (accessed 16 June 2016).
99.
ArcherJBowerPGilbodySLovellKRichardsDGaskLDickensCCoventryP. Collaborative care for depression and anxiety problems. Cochrane Database Syst Rev2012; 10: CD006525–CD006525.
100.
RollmanBL1BelnapBHMazumdarSHouckPRZhuFGardnerWReynoldsCF3rdSchulbergHCShearMK. A randomized trial to improve the quality of treatment for panic and generalized anxiety disorders in primary care. Arch Gen Psychiatry2005; 62: 1332–41.
101.
Roy-ByrnePCraskeMGSteinMBSullivanGBystritskyAKatonWGolinelliDSherbourneCD. A randomized effectiveness trial of cognitive-behavioral therapy and medication for primary care panic disorder. Arch Gen Psychiatry2005; 62: 290–8.
102.
TappHPhillipsSEWaxmanDAlexanderMBrownRHallM. Multidisciplinary team approach to improved chronic care management for diabetic patients in an urban safety net ambulatory care clinic. J Am Board Fam Med2012; 25: 245–6.
103.
Roy-ByrnePCraskeMGSteinMB. A randomized effectiveness trial of cognitive-behavioral therapy and medication for primary care panic disorder. Arch Gen Psychiatry2005; 62: 290–8.
104.
SpitzerRLKroenkeKWilliamsJBLoweB. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med2006; 166: 1092–7.
105.
KroenkeKSpitzerRLWilliamsJB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med2001; 16: 606–13.
106.
HomePMantJDiazJTurnerC. Management of type 2 diabetes: updated NICE guidance. Br Med J2008; 336: 306–8.
107.
HomePMantJDiazJTurnerC. Management of type 2 diabetes: summary of updated NICE guidance. BMJ2008; 336: 1306–8.
EspositoPMereuRDe BarbieriGRampinoTDi ToroAGroopPHDal CantonABernardiL. Trained breathing-induced oxygenation acutely reverses cardiovascular autonomic dysfunction in patients with type 2 diabetes and renal disease. Acta Diabetol2016; 53: 217–26.
110.
Noordali F, Cumming J, Thompson J. Effectiveness of mindfulness-based interventions on physiological and psychological complications in adults with diabetes: a systematic review. J Health Psychol. Epub ahead of print 30 December 2015. DOI: 10.1177/1359105315620293.
111.
LustmanPJGriffithLSClouseREFreedlandKEEisenSARubinEHCarneyRMMcGillJB. Effects of alprazolam on glucose regulation in adult diabetic patients: results of a double-blind, placebo-controlled trial. Diabetes Care1995; 18: 1133–9.
LustmanPJGriffithLSClouseREFreedlandKEEisenSARubinEHCarneyRMMcGillJB. Effects of nortriptyline on depression and glycemic control in diabetes: results of a double-blind, placebo-controlled trial. Psychosom Med1997; 59: 241–50.
116.
Esposito P, Mereu R, De Barbieri G, Rampino T, Di Toro A, Groop PH, Dal Canton A, Bernardi L. Trained breathing-induced oxygenation acutely reverses cardiovascular autonomic dysfunction in patients with type 2 diabetes and renal disease. Acta Diabetol 2015;53:217–26.
117.
ChaiopanontS. Hypoglycemic effect of sitting breathing meditation exercise on type 2 diabetes at Wat Khae Nok Primary Health Center in Nonthaburi province. J Med Assoc Thai2008; 91: 93–8.
