The Depression and Diabetes Dialogue (DDD)

The Dialogue on Diabetes and Depression (DDD) is an international collaborative initiative coordinated by AIMHP and  focusing on the comorbidity of depression and diabetes.  It has been the largest effort of its type ever undertaken.  It brought together 18 major nongovernmental organizations as well as numerous major institutes active in the field.  The list  below shows the members of the DDD at the end of 2011.

The DDD initiative aims to raise awareness about the magnitude and severity of problems related to the comorbidity of depression and diabetes and to improve its recognitiion and management in health services.  The choice of the comorbidity of depression and diabetes as a focus for action among the multitude of possible pairs of mental and physical diseases was pragmatic.  The prevalence of both diseases is high and increasing rapidly.  They are perhaps less stigmatized than many other long lasting mental and physical illnesses.  They occur together frequently and their simultaneous presence worsens the prognosis of both depression and diabetes.  The recognition  of comorbid depression and diabetes in health care system seems to be poor.  The reviews of comorbidity of mental and physical diseases carried out by AMH (Katon et al., 2007, 2010; Leucht et al., 2010, Kissane et al., 2011, Kurrle et al., ) did not identify any other pair of mental and physical disorders that would provide a better target for an initiave whose aim is to demonstrate how much can be done for persons suffering simultaneously from both mental and a physical illess by improving recognition and treatment of both diseases.

It is hoped that the DDD programme will open the door to similar initiatives addressing the comorbidity of other mental and physical disorders.  The development of such programmes is urgent.  The successes of medicine have let to an extension of life expectancy of people who suffer from chronic illnesses and disability, which increases the risk of comorbidity.  Longer life expenctancy also adds additional years of risk for comorbidity. Some treatments for chronic mental and chronic physical disorders have side effects that may lead to comorbidity.  Other factors that increase the likelihood of comorbidity are also becoming more commong, including for example, the abuse of alcohol and drugs and unhealthy life styles.

The increased prevalence of comorbidity is unfortunately occurring at a time when emdicine is going through a process of fragmentation into ever more focused disciplines. Public health authorities in many countries have promoted the development and strengthening of primary health care services but this has not prevented and ever-greater number of people from bypassing the general practigitioner and seeking help directly from specialists.  The increasing health literacy of populations worldwide (which diminishes the authority of the general health care worker) also contributes to the tendency to self-diagnosis and self-referral to specialists based on knowledge gleaned from the internet or learned from other modern information systems. Specialized services are, on the whole reluctant to do much about a comorbid disease that is outside their area of expertise, even when they recognize its presence. The competence of general health care workers and specialists other than psychiatrists to deal with psychiatric problems is on the whole limited, while the same is true for psychiatrists who rarely stay abreast with knowledge and skills of other branches of medicine.

In order to raise awareness about the comorbidity of depression and diabetes and to improve its recognition and management in health services, the Dialogue on Diabetes and Depression has taken four lines of action.  It produces reviews of knowledge about issues relevant to the recognition, understanding and treatment of comorbid depression and diabetes; it organizes symposia, lectures and keynote addresses at scientific meetings to increase the awareness of the magnitude and severity of problems caused by comorbidity; it produces training materials and models of education about comorbid diabetes and depression; and it stimulates and facilitates research relevant to its two aims stated above.

For full commentary by Sartorius and Cimino in the Journal of Affective Disorders see   The Dialogue on Diabetes and Depression (DDD)