Treatment for comorbid depressive disorder or subthreshold depression in diabetes mellitus: Systematic review and meta-analysis

Christina van der Feltz-Cornelis; Sarah F Allen; Richard I G Holt; Richard Roberts; Arie Nouwen; Norman Sartorius

doi:10.1002/brb3.1981

Treatment for comorbid depressive disorder or subthreshold depression in diabetes mellitus: Systematic review and meta-analysis

Brain Behav. 2021 Feb;11(2):e01981. doi: 10.1002/brb3.1981. Epub 2020 Dec 4.

Authors

Christina van der Feltz-Cornelis¹, Sarah F Allen¹, Richard I G Holt², Richard Roberts³, Arie Nouwen⁴, Norman Sartorius⁵

Affiliations

¹ Department of Health Sciences, Hull York Medical School, University of York, York, UK.
² Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK.
³ Department of Family Medicine & Community Health, University of Wisconsin, Madison, WI, USA.
⁴ Department of Psychology, Middlesex University, London, UK.
⁵ Association for the Improvement of Mental Health Programmes, Geneva, Switzerland.

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 HbA₁ c and depressive outcome. High baseline HbA₁ c was associated with a greater reduction in HbA₁ 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 HbA₁ 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.

Keywords: depression; diabetes mellitus; glycemic control; meta-analysis; systematic review; treatments.

Publication types

Meta-Analysis
Research Support, Non-U.S. Gov't
Review
Systematic Review

MeSH terms

Depression
Depressive Disorder* / epidemiology
Depressive Disorder* / therapy
Diabetes Mellitus, Type 1* / complications
Diabetes Mellitus, Type 1* / epidemiology
Diabetes Mellitus, Type 1* / therapy
Humans
Psychotherapy
Psychotherapy, Group*
Randomized Controlled Trials as Topic