Depression occurs in 20-25% of older African Americans with diabetic retinopathy (DR) and accelerates progression of DR by compromising diabetes self-management practices and raising hemoglobin A1C levels (HbA1C). Treating depression improves diabetes self-management and lowers HbA1C and may thereby prevent progression of DR. AAs, however, are less likely to be treated for depression than whites. Depression contributes to why AAs have worse glycemic control and higher rates of DR (39% vs. 26%), vision-threatening DR (9.3% vs. 3.2%), and legal blindness (7.3 vs. 5.4%) than whites. These disparities necessitate new interventions to treat depression, improve glycemic control, and prevent progression of DR in older AAs. We seek support for a planning grant to refine the methods, conduct a Feasibility Study, and develop a Manual of Procedures for a planned randomized controlled clinical trial (RCT) entitled, Collaborative Care for Depression and Diabetic Retinopathy (CC-DDR). CC-DDR is a novel mental health/ophthalmologic intervention that we are designing to treat depression and lower HbA1C levels in older AAs with mild-to-moderate DR and comorbid depression. Community Health Workers, who match participants in race and cultural background, will work with ophthalmologists in the retina clinic to educate participants on the links between depression, HbA1C, and DR, and will extend care into the home where they will use Behavior Activation to treat depression and improve diabetes self-management skills. Before moving to a full-scale RCT of CC-DDR, we propose a 3- stage planning grant. In Stage I we will: 1) develop the CC-DDR treatment protocol; 2) develop a tool to assess therapists' adherence and competency; and 3) seek input from a panel of experts to refine these materials. In Stage II we will conduct an open trial of CC-DDR to evaluate its feasibility. In Stage III we will develop the Manual of Procedures for the planned RCT of CC-DDR. As the population ages and the prevalence of DR rapidly increases in older AAs, a culturally relevant intervention that treats depression, lowers HbA1C, and prevents progression of DR is significant if we are to preserve vision in this population.
This research is significant and innovative because it is the first attempt to integrate a mental health/ophthalmologic intervention into routine retina practice and extend care into the home; it targets a high- risk underserved minority group; and it targets untreated depression, which accelerates progression of diabetic retinopathy. These innovations hold the promise that Collaborative Care for Depression and Diabetic Retinopathy will be more effective than existing interventions and will prevent blindness in this population.
