Disease management is a very broad concept, including different content, forms of care and organization. Nearly each trial implemented a unique programme consisting of various components. This illustrates the heterogeneity of the concept of disease management.The long-term impact of disease management programmes (DMPs) on health and health care systems still needs to be evaluated. The impact of DMPs on patients’ quality of life and on patients’ and providers’ satisfaction also remains to be assessed, as does evaluation of their cost-effectiveness.The strongest evidence available relates to programmes targeting diabetes, coronary heart disease and cardiac heart failure.
In Medicine, Disease Management refers to the processes and people concerned with improving or maintaining health in large numbers of people. As opposed to epidemiology, which is generally concerned with sudden or persistent virulent outbreaks of disease, Disease Management is concerned with common chronic illnesses and reduction of future complications associated with those diseases.
Illnesses that Disease Management would concern itself with would include: Coronary Artery Disease, Renal Failure, Hypertension, Congestive Heart Failure, Obesity, Diabetes, Asthma, Cancer, Arthritis, Depression and other common ailments.
Some people believe that depression is "normal" in people who are elderly, have other health problems, have setbacks or other tragedies, or have bad life situations. On the contrary, clinical depression is always abnormal and always requires attention from a medical or mental health professional.
Depression is a common risk factor for heart disease and can complicate recovery from a heart attack. Even minor depression is a significant risk for and appears to be related to future complications and even death. Depression is more likely to occur with certain medical conditions. These "co-occurring" conditions include heart disease, stroke, diabetes, cancer, hormonal disorders (especially hypothyroidism, or "low thyroid"), Parkinson disease, and Alzheimer disease. Clinical depression should not be considered a "normal" or "natural" reaction to such illness.
Diabetes and heart disease are related. Diabetes, being overweight and having high blood pressure are related. Heart disease affects the quality of life of millions of Americans and is the leading cause of death. The development of most heart disease is related to the way we live. Changing to a healthier lifestyle will help prevent both new and repeat heart problems. Diabetes, high blood pressure, and high cholesterol are major risk factors for heart disease. The same measures that help prevent or control these conditions will also reduce your risk for heart disease.
Like diabetes, high blood pressure can damage your blood vessels. When these two conditions team up, they can lead to a heart attack, stroke or other life-threatening conditions.Stress can increase your body's production of those hormones that block the effect of insulin, causing your blood sugar to rise. If you're under a lot of stress, you'll have a hard time taking care of yourself and managing your diabetes. You may not take the time to eat right, monitor your blood sugar, exercise or take your medication as prescribed. And prolonged stress can lead to depression.
Heart disease, diabetes and depression can be a lethal triple-play -- boosting a patient's death risk by 20 percent to 30 percent, new research shows.
"We do not know what this increased risk is due to, but it could either be that depression influences crucial aspects of self-care behaviors needed to manage diabetes or that a more severe disease process is reflected in more depressive symptoms," said lead researcher Anastasia Georgiades, a research associate in the department of psychiatry and behavioral science at Duke University in Durham, N.C.
Georgiades was expected to present the findings Friday at the American Psychosomatic Society annual meeting in Budapest, Hungary.
In their study, the Duke team followed 933 heart patients for more than four years. During that time, there were 135 deaths among patients with type 2 diabetes and/or depression, the researchers found.
Among patients with moderate-to-severe symptoms of depression who were also diabetics, the researchers observed a significant 30 percent greater risk of dying over the four-year period compared with patients with either depression alone or diabetes alone.
These data suggest that diabetes and depression exacerbate each other, but the reasons for this relationship aren't clear.
"The results from the present study will need to be replicated, since they are far from conclusive," Georgiades said. "Future research will also aim to investigate the mechanisms behind the associations closer. In the meantime, our advice is that physicians monitor these potential high-risk patients carefully," she said.
Co-author Lana Watkins, an assistant research professor also in Duke's department of psychiatry and behavioral sciences, noted that "if you or a loved one has coronary artery disease and diabetes, depression may impact your survival, particularly if it's severe enough to interfere with your daily activities."
"Talk to your doctor and check whether you can get help for your depression, either through medicines or through changes in your life, like social activities or exercise," Watkins advised.
One expert said the findings confirm previous data.
"This is an interesting study that replicates earlier work showing that symptoms of depression are associated with survival in persons with coronary artery disease," said Robert M. Carney, a professor of psychiatry and director of the Behavioral Medicine Center at Washington University School of Medicine in St. Louis.
Other studies have shown that depression is very common in patients with diabetes, and it is associated with poorer metabolic control and long-term complications in these patients, Carney said.
"The researchers also report a possible interaction between depression and diabetes in patients with coronary artery disease, such that having both disorders may more than additively increase the risk for mortality," the expert noted.
"This is potentially a very important finding, as it suggests a possible link between these two risk factors," Carney said. "This could help to identify those individuals at highest risk for dying and possibly lead to novel treatment strategies to improve survival in these patients."
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