Perspectives From Training the Care Coordinators - a New Cadre to Support Team-based Diabetes and Depression Care in India: INDEPENDENT Study

Purpose: Comorbid depression and type 2 diabetes are associated with poor glycemic control, increased complications, and poor self-management, compared to either condition alone. The Integrating Depression and Diabetes Treatment (INDEPENDENT) clinical trial demonstrated the effectiveness of an integrated care model in improving diabetes and depression outcomes, in diabetes-specialty clinics in India. The INDEPENDENT model used task sharing to address the shortage of mental health professionals in India. Care coordinators (CCs) who were dietitians or counsellors were a key component of this care model. This article details the training and support provided to the CCs during the INDEPENDENT trial. Materials and Methods: CCs were nonphysician and nonpsychiatrist health specialists who supported patients in self-management of diabetes and depression, helping them set achievable goals and monitored progress. During the clinical trial, the CCs underwent both offsite and on-site trainings. The trainings equipped them with various lifestyle management tools for self-care, including one-on-one education sessions and motivational interviewing for self-monitoring, adherence to medication, diet, exercise regimes, and cessation of smoking, among others. Results: Nine CCs from the four sites were trained effectively during the course of the INDEPENDENT study from 2014 to 2018. Conclusions: Given the paucity of mental health professionals in India, the use of collaborative care and a team of well-trained CCs may be an effective strategy for the management of comorbid depression and diabetes. This model of care could help fill deficiencies in the delivery of care for comorbidity of depression and diabetes care in India.