Integrated Treatment of Diabetes and Depression in India is Cost-Effective

Cost-Effectiveness of a Collaborative Care Model Among Patients With Type 2 Diabetes and Depression in India. Diabetes Care 2022


According to a current study with DZD involvement, integrated treatment of patients with type 2 diabetes and depression in India not only contributes to better patient treatment, but is also more cost-effective. The results are now being published in Diabetes Care.

The researchers analyzed the costs and efficacy across four municipal clinics in India, based on a multi-payer and community perspective. The randomized clinical trial recruited 404 patients with poorly controlled type 2 diabetes (HbA1c ≥8.0%, systolic blood pressure ≥140 mmHg or LDL cholesterol ≥130 mg/dL) and depressive symptoms (9-point Patient Health Questionnaire score of ≥10) who were randomized into two arms: in the first, patients received collaborative care for 12 months, in which they received mental health coaching from non-physician care coordinators, electronic health record management and specialist-supported discussion of their case. This was followed by 12 months of conventional treatment. In the second treatment arm, patients received standard care for 24 months. The study showed that integrated care was not only effective (the clinical results of the INDEPENDENT study were published in the JAMA journal in 2020,, but can also be cost-effective. This applies especially if the collaborative care is well integrated into clinical routine and its processes.

The first author Karl Emmert-Fees outlines the results of the study: "The study shows for the first time that integrated care in this type of setting is cost-effective and that its implementation can contribute to better and more efficient care for diabetes and depression in India".
This study can be used to enhance and implement integrated care models for similar contexts and can also contribute to international guidelines on the care of patients with non-communicable diseases and mental health comorbidities.

In the next step, the researchers seek to investigate the long-term effects of the intervention
and identify which components of integrated care have the greatest impact on patient health and the associated costs.

Original publication:
Karl M.F. Emmert-Fees, Michael Laxy, Shivani A. Patel, Kavita Singh, Subramani Poongothai, Viswanathan Mohan, Lydia Chwastiak, K.M. Venkat Narayan, Rajesh Sagar, Aravind R. Sosale, Ranjit Mohan Anjana, Gumpeny R. Sridhar, Nikhil Tandon, Mohammed K. Ali; Cost-Effectiveness of a Collaborative Care Model Among Patients With Type 2 Diabetes and Depression in India. Diabetes Care 2022; dc212533. DOi:

Participants in the study:
Institute of Epidemiology, Helmholtz Munich, Public Health and Prevention, TU Munich, Emory Global Diabetes Research Center, Emory University Atlanta, (USA) Madras Diabetes Research Foundation (Indien)