Depressive symptoms occur in 20% of diabetes patients but stay untreated in 50% of the cases. The combination of depression and diabetes adversely affects quality of life, glycaemic control, complications and mortality. Psychological therapies are effective, but have low reach in diabetes. Therefore, we developed a web-based, guided self-help program based on Cognitive Behaviour Therapy: “Diabetergestemd.nl” (DbG). In a RCT DbG was superior to waiting-list control group, with a significant reduction in depressive symptoms in 50% of the participants. We are currently conducting a nationwide implementation study, offering DbG as guided self-help program as part of ongoing diabetes care.

DbG includes online depression screening (PHQ-9). Suicidal ideation, bipolar depression, schizophrenia are excluded. Depression and diabetes-distress are assessed pre- and post DbG, along with a user evaluation. To understand inhibiting and facilitating factors with regard to the adoption of DbG, diabetes professionals and patients are interviewed. Based on the knowledge from this implementation study, recommendations can be made to promote further dissemination. Preliminary results indicate patient satisfaction with the availability DbG and possibility of self-referral. Diabetes professionals, in contrast, stress the importance of professional referral and being informed about patients participating. Although DbG is evidence-based, some diabetes professionals are critical as to the effectiveness and suitability of web-based treatment for depression.

Web-based treatment of co-morbid diabetes and depression is effective, appreciated and feasible, but broad adoption in diabetes care will depend much on uptake by physicians.