# Depression Treatment to Reduce the Excess Diabetes Risk of People with Depression and Prediabetes

> **NIH NIH R21** · INDIANA UNIVERSITY INDIANAPOLIS · 2021 · $178,760

## Abstract

PROJECT SUMMARY/ABSTRACT
Diabetes affects 31 million (12%) U.S. adults, and another 82 million (34%) adults have prediabetes, a
precursor to diabetes. The ramifications of diabetes are grave and include cardiovascular disease, disability,
and death. While these statistics highlight the importance of diabetes prevention, current approaches have only
partial effectiveness. This has created a clear need to identify new primary prevention targets and approaches
for diabetes, and depression and depression treatment are strong candidates in this regard. Over 20 years of
evidence indicates that depression is an independent, clinically important, robust, biobehaviorally plausible,
and modifiable risk factor for diabetes. However, research has yet to determine whether depression treatment
can prevent the development of diabetes in people with prediabetes. Given that depression is still receiving
limited attention in settings where diabetes prevention occurs (e.g., primary care), there is a large cohort of
patients with an underdetected or undertreated diabetes risk factor (depression). This status quo and the
strong state of the depression-to-diabetes science create the need for a pilot RCT to evaluate the utility of
depression treatment as a new diabetes prevention strategy. Thus, we propose a pilot RCT of 64 primary care
patients (50% minority) with a depressive disorder and prediabetes. Patients will be randomized to 6 months of
eIMPACT-DM (intervention) or Active Control (comparator). eIMPACT-DM is our modernized collaborative
stepped care intervention consisting of (1) computerized and telephonic cognitive-behavioral therapy for
depression and (2) select antidepressant medications included in an algorithm optimized for diabetes risk
reduction. Our preliminary data establish the feasibility and antidepressive efficacy of eIMPACT-DM. The
Active Control consists of depression education, symptom monitoring, and primary care for depression. Our
primary aim is to determine the preliminary efficacy of eIMPACT-DM in improving the diabetes risk markers of
hemoglobin A1c (primary outcome) and insulin resistance (secondary outcome). Our exploratory aim is to
explore whether somatic depressive symptoms – i.e., hyperphagia (increased appetite/weight) and/or
hypersomnia (increased sleep) – moderate the effect of eIMPACT-DM on diabetes risk markers. A positive
pilot trial would pave the way to an R01-level RCT by: (1) generating critical proof-of-concept data (eIMPACT-
DM can improve A1c) to support the premise of the definitive trial; (2) providing preliminary effect sizes for
eIMPACT-DM on diabetes risk markers to help justify future power analyses; (3) identifying a potentially
important moderator of eIMPACT-DM efficacy that may need to be incorporated into the definitive trial.
Ultimately, demonstrating that depression treatment reduces diabetes risk would identify a novel target
(depression) for diabetes prevention efforts, and it would equip healthcare provid...

## Key facts

- **NIH application ID:** 10092154
- **Project number:** 5R21DK123582-02
- **Recipient organization:** INDIANA UNIVERSITY INDIANAPOLIS
- **Principal Investigator:** Jesse C Stewart
- **Activity code:** R21 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $178,760
- **Award type:** 5
- **Project period:** 2020-02-01 → 2023-07-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10092154

## Citation

> US National Institutes of Health, RePORTER application 10092154, Depression Treatment to Reduce the Excess Diabetes Risk of People with Depression and Prediabetes (5R21DK123582-02). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/10092154. Licensed CC0.

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