INTEGRATED MANAGEMENT OF TYPE 2 DIABETES AND DEPRESSION IN PRIMARY CARE A NARRATIVE REVIEW

Authors

DOI:

https://doi.org/10.71000/j5yrd383

Keywords:

Type 2 Diabetes Mellitus, Depression, Integrated Care, Primary Health Care, Multidisciplinary Management, Narrative Review

Abstract

Background: Type 2 diabetes mellitus (T2DM) and depression are among the most prevalent chronic conditions globally, frequently co-occurring and compounding one another’s severity and management complexity. Their bidirectional relationship adversely impacts treatment adherence, glycemic control, and overall quality of life. Primary care settings, as the frontline of healthcare, offer an optimal platform for integrated management, yet conventional approaches often remain fragmented.

Objective: This narrative review aims to explore the current landscape of integrated care models for the concurrent management of T2DM and depression in primary care, highlighting their effectiveness, challenges, and future directions.

Main Discussion Points: The review synthesizes findings from recent literature emphasizing the value of multidisciplinary collaboration, including the use of case managers, mental health professionals, and primary care physicians. Integrated care models such as CIC-PDD demonstrate improvements in both metabolic and mental health outcomes, self-care behaviors, and patient satisfaction. Key themes include clinical efficacy, patient-centered care, health system efficiency, cultural adaptability, and cost-effectiveness. Limitations noted across studies include methodological inconsistencies, short follow-up durations, and challenges in scalability and generalizability.

Conclusion: Integrated care for T2DM and depression in primary settings shows strong clinical promise, with evidence supporting improved patient outcomes and system-level efficiencies. However, further high-quality, long-term, and diverse studies are essential to establish standardized, sustainable, and globally applicable models.

Author Biographies

  • Mehwish Farooq, Aga Khan University, Karachi, Pakistan.

    Research Associate, Aga Khan University, Karachi, Pakistan.

  • Akif Saeed Ch, Hope Family Clinic, Faisalabad, Pakistan.

    Director Medical Services & Research, Hope Family Clinic, Faisalabad, Pakistan.

  • Hamd E Yazdaan, Rehman Medical College, Peshawar, Pakistan.

    Lecturer Pathology, Rehman Medical College, Peshawar, Pakistan.

  • Tahir Hafeez, Tahir Holistic Healing & Research Institute, Mandi Bahauddin, Pakistan.

    CEO & Founder, Tahir Holistic Healing & Research Institute, Mandi Bahauddin, Pakistan.

  • Mahwish Ashraf, Wah Medical College, Wah Cantt, Pakistan.

    Wah Medical College, Wah Cantt, Pakistan.

  • Numan Akram, Services Institute of Medical Sciences, Lahore , Pakistan.

    Ex-House Officer, Services Hospital Lahore; MBBS, Services Institute of Medical Sciences, Lahore , Pakistan.

References

Ren M, Zhang H, Qi J, Hu A, Jiang Q, Hou Y, et al. An Almond-Based Low Carbohydrate Diet Improves Depression and Glycometabolism in Patients with Type 2 Diabetes through Modulating Gut Microbiota and GLP-1: A Randomized Controlled Trial. Nutrients. 2020;12(10).

Wang J, Zhou D, Dai Z, Li X. Association Between Systemic Immune-Inflammation Index and Diabetic Depression. Clin Interv Aging. 2021;16:97-105.

Maina JG, Balkhiyarova Z, Nouwen A, Pupko I, Ulrich A, Boissel M, et al. Bidirectional Mendelian Randomization and Multiphenotype GWAS Show Causality and Shared Pathophysiology Between Depression and Type 2 Diabetes. Diabetes Care. 2023;46(9):1707-14.

Amsah N, Md Isa Z, Ahmad N. Biopsychosocial and Nutritional Factors of Depression among Type 2 Diabetes Mellitus Patients: A Systematic Review. Int J Environ Res Public Health. 2022;19(8).

Fortmann A, Walker C, Barger K, Robacker M, Morrisey R, Ortwine K, et al. Care Team Integration in Primary Care Improves One-Year Clinical and Financial Outcomes in Diabetes: A Case for Value-Based Care. Population health management. 2020.

Abbas Q, Latif S, Ayaz Habib H, Shahzad S, Sarwar U, Shahzadi M, et al. Cognitive behavior therapy for diabetes distress, depression, health anxiety, quality of life and treatment adherence among patients with type-II diabetes mellitus: a randomized control trial. BMC Psychiatry. 2023;23(1):86.

Wang Y, Guo D, Wang M, Hu M, Zhu D, Yu Q, et al. Community-based integrated care for patients with diabetes and depression (CIC-PDD): study protocol for a cluster randomized controlled trial. Trials. 2023;24.

Yu X, Tian S, Wu L, Zheng H, Liu M, Wu W. Construction of a depression risk prediction model for type 2 diabetes mellitus patients based on NHANES 2007-2014. J Affect Disord. 2024;349:217-25.

Wang W, Guo D, Xia Y, Hu M, Wang M, Shi Z, et al. Cost-effectiveness of community-based integrated care model for patients with diabetes and depressive symptoms. Nature Communications. 2025;16.

Ruan X, Chen J, Sun Y, Zhang Y, Zhao J, Wang X, et al. Depression and 24 gastrointestinal diseases: a Mendelian randomization study. Transl Psychiatry. 2023;13(1):146.

Zou Y, You W, Wang J, Wang F, Tian Z, Lu J, et al. Depression and Retinopathy in Patients With Type 2 Diabetes Mellitus: A Meta-Analysis. Psychosom Med. 2021;83(3):239-46.

Lemogne C, Chauvet-Gelinier JC. Depression and the risk of type 2 diabetes. J Psychosom Res. 2023;164:111116.

Liu K, Zhou D, Chen L, Hao S. Depression and type 2 diabetes risk: a Mendelian randomization study. Front Endocrinol (Lausanne). 2024;15:1436411.

Khawagi WY, Al-Kuraishy HM, Hussein NR, Al-Gareeb AI, Atef E, Elhussieny O, et al. Depression and type 2 diabetes: A causal relationship and mechanistic pathway. Diabetes Obes Metab. 2024;26(8):3031-44.

Wang Y, Guo D, Xia Y, Hu M, Wang M, Yu Q, et al. Effect of Community-Based Integrated Care for Patients With Diabetes and Depression (CIC-PDD) in China: A Pragmatic Cluster-Randomized Trial. Diabetes Care. 2024;48:226-34.

He P, Wang Y. Effect of Community-based integrated care for patients with diabetes and depression in China: interim analysis of a pragmatic cluster-randomized trial. International Journal of Integrated Care. 2025.

Castañeda S, Gallo L, Garcia M, Mendoza P, Gutierrez A, Lopez-Gurolla M, et al. Effectiveness of an integrated primary care intervention in improving psychosocial outcomes among Latino adults with diabetes: the LUNA-D study. Translational behavioral medicine. 2022.

Basiri R, Seidu B, Rudich M. Exploring the Interrelationships between Diabetes, Nutrition, Anxiety, and Depression: Implications for Treatment and Prevention Strategies. Nutrients. 2023;15(19).

Cooper DH, Ramachandra R, Ceban F, Di Vincenzo JD, Rhee TG, Mansur RB, et al. Glucagon-like peptide 1 (GLP-1) receptor agonists as a protective factor for incident depression in patients with diabetes mellitus: A systematic review. J Psychiatr Res. 2023;164:80-9.

Yao J, Zhu CQ, Sun Y, Huang YW, Li QH, Liao HM, et al. Insulin resistance: The role in comorbid type 2 diabetes mellitus and depression. Neurosci Biobehav Rev. 2025;175:106218.

Laiteerapong N, Staab E, Wan W, Quinn M, Campbell A, Gedeon S, et al. Integration of Diabetes and Depression Care Is Associated with Glucose Control in Midwestern Federally Qualified Health Centers. Journal of General Internal Medicine. 2021:1-7.

Fanelli G, Raschi E, Hafez G, Matura S, Schiweck C, Poluzzi E, et al. The interface of depression and diabetes: treatment considerations. Translational Psychiatry. 2025;15.

Li S, Yang D, Zhou X, Chen L, Liu L, Lin R, et al. Neurological and metabolic related pathophysiologies and treatment of comorbid diabetes with depression. CNS Neurosci Ther. 2024;30(4):e14497.

Tao H, Fan S, Zhu T, You L, Zheng D, Yan L, et al. Psychiatric disorders and Type 2 diabetes mellitus: A bidirectional Mendelian randomization. Eur J Clin Invest. 2023;53(3):e13893.

de Paiva IHR, da Silva RS, Mendonça IP, de Souza JRB, Peixoto CA. Semaglutide Attenuates Anxious and Depressive-Like Behaviors and Reverses the Cognitive Impairment in a Type 2 Diabetes Mellitus Mouse Model Via the Microbiota-Gut-Brain Axis. J Neuroimmune Pharmacol. 2024;19(1):36.

Subba R, Ahmad MH, Ghosh B, Mondal AC. Targeting NRF2 in Type 2 diabetes mellitus and depression: Efficacy of natural and synthetic compounds. Eur J Pharmacol. 2022;925:174993.

van der Feltz-Cornelis C, Allen SF, Holt RIG, Roberts R, Nouwen A, Sartorius N. Treatment for comorbid depressive disorder or subthreshold depression in diabetes mellitus: Systematic review and meta-analysis. Brain Behav. 2021;11(2):e01981.

Downloads

Published

2025-08-06

How to Cite

1.
Farooq M, Akif Saeed Ch, Hamd E Yazdaan, Tahir Hafeez, Mahwish Ashraf, Numan Akram. INTEGRATED MANAGEMENT OF TYPE 2 DIABETES AND DEPRESSION IN PRIMARY CARE A NARRATIVE REVIEW. IJHR [Internet]. 2025 Aug. 6 [cited 2025 Aug. 29];3(4 (Health and Allied):417-23. Available from: https://insightsjhr.com/index.php/home/article/view/1204