COMRADE: Collaborative Care Management for Distress and Depression in Rural Diabetes

The investigators plan to implement and evaluate, using a pragmatic comparative effectiveness trial, a unique collaborative, stepped-care intervention for patients with uncontrolled Type 2 diabetes and co-morbid distress and/or depression. The investigators approach will combine practice-based medical and cognitive behavioral treatment with strong community-based support to immediately place the patient at the right level of intervention based on disease and severity and to step-up treatment intensity and follow-up if the initial response is inadequate. The practice-based component will use a care manager linked to medical, pharmacologic, and behavioral colleagues. The community based component will utilize community health workers to provide support and facilitate access to resources. Goals include: 1) implementing and evaluating the effectiveness of this intervention; 2) examining the impact of this approach on psychological mediators of improved glycosylated hemoglobin (HbA1c); and 3) building, sustaining, and disseminating a cost-effective care model.

Inclusion criteria

• Clinical Diagnosis of Type 2 diabetes mellitus
• Glycosylated Hemoglobin (HbA1c) > 7.0 = Uncontrolled
• Positive score on diabetes related distress 2 question screener and/or
• Positive score on Patient Health Questionnaire (PHQ-2) 2 question screener

Exclusion criteria

a diagnosis [from billing records using International Classification of Disease, 9th Edition (ICD-9) codes] of:

• advanced disease (e.g., end stage renal disease, advanced heart failure, blindness, metastatic cancer and including those who are in active treatment for cancer), or
• alcoholism or
• cognitive impairment, or
• major psychiatric disease or
• any type of physical or mental impairment that would preclude active participation