Open AccessTreatment for comorbid depressive disorder or subthreshold depression in diabetes mellitus: Systematic review and meta‐analysis
Author(s) -
van der FeltzCornelis Christina,
Allen Sarah F.,
Holt Richard I. G.,
Roberts Richard,
Nouwen Arie,
Sartorius Norman
Publication year - 2021
Publication title -
brain and behavior
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.915
H-Index - 41
ISSN - 2162-3279
DOI - 10.1002/brb3.1981
Subject(s) - medicine , meta analysis , randomized controlled trial , glycemic , depression (economics) , major depressive disorder , cochrane library , psychological intervention , placebo , type 2 diabetes , late life depression , diabetes mellitus , physical therapy , psychiatry , endocrinology , insulin , alternative medicine , hippocampal formation , pathology , economics , macroeconomics , amygdala
Abstract Objective To provide an estimate of the effect of interventions on comorbid depressive disorder (MDD) or subthreshold depression in type 1 and type 2 diabetes. Methods Systematic review and meta‐analysis. We searched PubMed, PsycINFO, Embase, and the Cochrane Library for randomized controlled trials evaluating the outcome of depression treatments in diabetes and comorbid MDD or subthreshold symptoms published before August 2019 compared to care as usual (CAU), placebo, waiting list (WL), or active comparator treatment as in a comparative effectiveness trial (CET). Primary outcomes were depressive symptom severity and glycemic control. Cohen's d is reported. Results Forty‐three randomized controlled trials (RCTs) were selected, and 32 RCTs comprising 3,543 patients were included in the meta‐analysis. Our meta‐analysis showed that, compared to CAU, placebo or WL, all interventions showed a significant effect on combined outcome 0,485 (95% CI 0.360; 0.609). All interventions showed a significant effect on depression. Pharmacological treatment, group therapy, psychotherapy, and collaborative care had a significant effect on glycemic control. High baseline depression score was associated with a greater reduction in HbA 1 c and depressive outcome. High baseline HbA 1 c was associated with a greater reduction in HbA 1 c. Conclusion All treatments are effective for comorbid depression in type 1 diabetes and type 2 diabetes. Over the last decade, new interventions with large effect sizes have been introduced, such as group‐based therapy, online treatment, and exercise. Although all interventions were effective for depression, not all treatments were effective for glycemic control. Effective interventions in comorbid depressive disorder may not be as effective in comorbid subthreshold depression. Baseline depression and HbA 1 c scores modify the treatment effect. Based on the findings, we provide guidance for treatment depending on patient profile and desired outcome, and discuss possible avenues for further research.