PESHAWAR: Khyber Medical University in collaboration with University of York, UK, has launched a four-year programme to ascertain the prevalence of depression among diabetes patients in Khyber Pakhtunkhwa and recommend appropriate measures to cope with the situation.

“We will randomly select districts for the trial and once we get the positive results then can be scalable. Currently there are eight per cent people, who are unaware that they have diabetes. Many of already diagnosed patients have poor diabetic control,” KMU Vice-chancellor Prof Ziaul Haq told Dawn.

The study “Developing and Evaluation an Adapted Behavioural Activation Intervention for People with Depression and Diabetes in South Asia” worth £3 million, a multi-country and multi-centre research project, is funded by the National Institute for Health Research (NIHR), UK. It is meant to develop and test a culturally appropriate approach for recognition and treatment of depression among people with diabetes in Pakistan and Bangladesh.

Prof Zia, the principal investigator of the project, said that they would develop a culturally relevant and scalable intervention delivered by non-specialists and integrated within diabetes and depression multi-morbidity (DiaDeM). It includes testing feasibility and economic impact of depression of DiaDeM and developing procedures for a full trial evaluation.

Prof Zia says 8pc patients don’t know they are diabetic

“Additionally, we will evaluate the clinical and cost-effectiveness of DiaDeM versus optimised usual care to estimate the economic impacts of depression and diabetes multi-morbidity,” he said.

He said that the main lead of the trial included Dr Najma Siddiqui and Dr Kamran Siddiqui, University of York, with funding from NIHR, UK. “We are collaborating with Rawalpindi Medical University and Baqai Medical University Karachi. KMU’s Dr Saima Afaq is co-supervisor,” said Prof Zia.

Roughly every fourth or fifth person is diabetic and this will further increase. “We need to shift the management of diabetes to the primary and secondary healthcare level. Healthcare systems in low and middle income countries face the growth of mental and physical multi-morbidity. People with long-term physical health conditions such as diabetes have a two or three folds increased risk of depression,” he said.

Prof Zia said that outcomes for comorbid depression and diabetes were significantly worse for both conditions. Diabetes is rapidly increasing, particularly in South Asia where depression in type 2 diabetes represents the largest combined mental and non-communicable disease burden.

“A joint approach to care is needed using a scalable intervention to recognise and treat depression, integrated with diabetes care. Behavioural Activation (BA) is a relatively simple, effective and culturally portable psychological therapy for depression, which can be delivered by non-specialists,” he said.

The KMU vice-chancellor said that primary outcome would be depression severity in six months, secondary outcomes included diabetes self-management, glycaemic control, health-related quality of life and depression severity in 12 months. He added that cost-effectiveness would be assessed from alternative perspectives, reflecting the expenditure on public and private healthcare and out-of-pocket expenses.

He said that potential impact would be maximised by an ‘Impact Working Group’ including the community panels, healthcare practitioners and policymakers. “If proves effective, it will plan the integration of the intervention into routine care and disseminate findings using social media, websites, reports, conferences and newspaper and journal articles,” he added.

Prof Zia said that DiaDeM had potential to improve mental and physical health, reduce inequalities and stigma for vulnerable groups and provide economic benefit. “Building on our existing collaborations, the programme will further enhance capacity in applied mental-physical multi-morbidity research and policymaking,” he added.

He said that said that the study also included raising awareness among people regarding diabetes, its early diagnosis and treatment. Preventive measures regarding the disease were also part of the programme to ensure that the people stayed from the ailment, he added.

Published in Dawn, April 12th, 2023