Lifestyle and Medication Management to Lower Diabetes Risk in Severe Mental Illness

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 DESCRIPTION (provided by applicant): Depression and type 2 diabetes are related pressing public health problems. Depression, antidepressant medications, and the health risk behaviors they are associated with, are all risk factors for type 2 diabetes. The overarching goal of this study is to test the additive effects of two proven health interventions - lifestyle modification ad medication therapy management - on risk for diabetes in persons with depression and functional impairment. Treatments will be delivered through our model designed for patients with mental illness (MI) whose care is challenged by distance, disability, language, and culture. Cambodian Americans are ideally suited for this research question because, compared to the general population and other Asian Americans they have: 1) high rates of diabetes and disability; 2) high rates of MI; 3) high rates of polypharmacy and medication problems; and, 4) a worse profile of the social determinants of health. We will recruit 210 adult Cambodian Americans with major depressive disorder and associated impaired functioning, and who are at high risk for diabetes, from our network of community based organizations in the northeast. Seventy participants each will be assigned to one of three arms. In the lifestyle arm, Community Health Workers (CHWs) will deliver the lifestyle intervention during weekly-to-triweekly tapered group sessions and 5 individual home visits over 18 months. In the combination arm, in addition to lifestyle, a pharmacist will join the patient and CHW during home visits via telemedicine to deliver medication therapy management, during 5 home visits over 18 months. In the enhanced standard care arm, participants will receive their usual healthcare enhanced by supportive services. Participants will be assessed at baseline, 1 year, and 2 years. We hypothesize that 1) compared to enhanced standard care, the lifestyle intervention will produce greater improvements in depressive symptoms, medication adherence, objective physical activity, objective sleep quality, and nutrition; and 2) compared to either intervention alone, the combined treatment will improve insulin sensitivity, HbA1c, c-reactive protein, anthropmetrics, blood pressure, lipids and depressive symptoms. If successful, these approaches may apply to other communities with barriers to care and produce diabetes prevention interventions for patients with MI.