Generic placeholder image

Current Diabetes Reviews

Editor-in-Chief

ISSN (Print): 1573-3998
ISSN (Online): 1875-6417

Systematic Review Article

Associations between HbA1c Reduction and Change in Depressive Symptoms following Glucose-lowering Treatment in Adults: A Systematic Review of Intervention Studies

Author(s): Andreas Schmitt, Magdalena Beran, Anouk Geraets, Marjolein M. Iversen, Giesje Nefs, Arie Nouwen, Frans Pouwer, Jörg W. Huber and Miranda T. Schram*

Volume 20, Issue 3, 2024

Published on: 16 August, 2023

Article ID: e020623217607 Pages: 18

DOI: 10.2174/1573399820666230602124223

Price: $65

Abstract

Introduction: Hyperglycemia constitutes a likely pathway linking diabetes and depressive symptoms; lowering glycemic levels may help reduce diabetes-comorbid depressive symptoms. Since randomized controlled trials can help understand temporal associations, we systematically reviewed the evidence regarding the potential association of hemoglobin HbA1c lowering interventions with depressive symptoms.

Methods: PubMed, PsycINFO, CINAHL, and EMBASE databases were searched for randomized controlled trials evaluating HbA1c-lowering interventions and including assessment of depressive symptoms published between 01/2000-09/2020. Study quality was evaluated using the Cochrane Risk of Bias tool. PROSPERO registration: CRD42020215541.

Results: We retrieved 1,642 studies of which twelve met our inclusion criteria. Nine studies had high and three unclear risks of bias. Baseline depressive symptom scores suggest elevated depressive symptoms in five studies. Baseline HbA1c was <8.0% (<64 mmol/mol) in two, 8.0-9.0% (64-75 mmol/mol) in eight, and ≥10.0% (≥86 mmol/mol) in two studies. Five studies found greater HbA1c reduction in the treatment group; three of these found greater depressive symptom reduction in the treatment group. Of four studies analyzing whether the change in HbA1c was associated with the change in depressive symptoms, none found a significant association. The main limitation of these studies was relatively low levels of depressive symptoms at baseline, limiting the ability to show a lowering in depressive symptoms after HbA1c reduction.

Conclusions: We found insufficient available data to estimate the association between HbA1c reduction and depressive symptom change following glucose-lowering treatment. Our findings point to an important gap in the diabetes treatment literature. Future clinical trials testing interventions to improve glycemic outcomes might consider measuring depressive symptoms as an outcome to enable analyses of this association.

Keywords: Diabetes mellitus, depressive symptoms, HbA1c, intervention, randomized controlled trial, hyperglycemia.

[1]
Anderson RJ, Freedland KE, Clouse RE, Lustman PJ. The prevalence of comorbid depression in adults with diabetes: A meta-analysis. Diabetes Care 2001; 24(6): 1069-78.
[http://dx.doi.org/10.2337/diacare.24.6.1069] [PMID: 11375373]
[2]
Barnard KD, Skinner TC, Peveler R. The prevalence of co-morbid depression in adults with Type 1 diabetes: systematic literature review. Diabet Med 2006; 23(4): 445-8.
[http://dx.doi.org/10.1111/j.1464-5491.2006.01814.x] [PMID: 16620276]
[3]
Roy T, Lloyd CE. Epidemiology of depression and diabetes: A systematic review. J Affect Disord 2012; 142 (Suppl.): S8-S21.
[http://dx.doi.org/10.1016/S0165-0327(12)70004-6] [PMID: 23062861]
[4]
Lloyd CE, Nouwen A, Sartorius N, et al. Prevalence and correlates of depressive disorders in people with Type 2 diabetes: results from the International Prevalence and Treatment of Diabetes and Depression (INTERPRET-DD) study, a collaborative study carried out in 14 countries. Diabet Med 2018; 35(6): 760-9.
[http://dx.doi.org/10.1111/dme.13611] [PMID: 29478265]
[5]
Lustman PJ, Anderson RJ, Freedland KE, de Groot M, Carney RM, Clouse RE. Depression and poor glycemic control: A meta-analytic review of the literature. Diabetes Care 2000; 23(7): 934-42.
[http://dx.doi.org/10.2337/diacare.23.7.934] [PMID: 10895843]
[6]
Schmitz N, Gariépy G, Smith KJ, et al. Recurrent subthreshold depression in type 2 diabetes: An important risk factor for poor health outcomes. Diabetes Care 2014; 37(4): 970-8.
[http://dx.doi.org/10.2337/dc13-1832] [PMID: 24198303]
[7]
Nouwen A, Adriaanse MC, Dam K, et al. Longitudinal associations between depression and diabetes complications: A systematic review and meta‐analysis. Diabet Med 2019; 36(12): 1562-72.
[http://dx.doi.org/10.1111/dme.14054] [PMID: 31215077]
[8]
Farooqi A, Khunti K, Abner S, Gillies C, Morriss R, Seidu S. Comorbid depression and risk of cardiac events and cardiac mortality in people with diabetes: A systematic review and meta-analysis. Diabetes Res Clin Pract 2019; 156: 107816.
[http://dx.doi.org/10.1016/j.diabres.2019.107816] [PMID: 31421139]
[9]
van Dooren FEP, Nefs G, Schram MT, Verhey FRJ, Denollet J, Pouwer F. Depression and risk of mortality in people with diabetes mellitus: A systematic review and meta-analysis. PLoS One 2013; 8(3): e57058.
[http://dx.doi.org/10.1371/journal.pone.0057058]
[10]
Katon WJ, Rutter C, Simon G, et al. The association of comorbid depression with mortality in patients with type 2 diabetes. Diabetes Care 2005; 28(11): 2668-72.
[http://dx.doi.org/10.2337/diacare.28.11.2668] [PMID: 16249537]
[11]
Gonzalez JS, Peyrot M, McCarl LA, et al. Depression and diabetes treatment nonadherence: A meta-analysis. Diabetes Care 2008; 31(12): 2398-403.
[http://dx.doi.org/10.2337/dc08-1341] [PMID: 19033420]
[12]
Russo VC, Higgins S, Werther GA, Cameron FJ. Effects of fluctuating glucose levels on neuronal cells in vitro. Neurochem Res 2012; 37(8): 1768-82.
[http://dx.doi.org/10.1007/s11064-012-0789-y] [PMID: 22565596]
[13]
Moulton CD, Costafreda SG, Horton P, Ismail K, Fu CHY. Meta-analyses of structural regional cerebral effects in type 1 and type 2 diabetes. Brain Imaging Behav 2015; 9(4): 651-62.
[http://dx.doi.org/10.1007/s11682-014-9348-2] [PMID: 25563229]
[14]
Penckofer S, Quinn L, Byrn M, Ferrans C, Miller M, Strange P. Does glycemic variability impact mood and quality of life? Diabetes Technol Ther 2012; 14(4): 303-10.
[http://dx.doi.org/10.1089/dia.2011.0191] [PMID: 22324383]
[15]
Snoek FJ, Bremmer MA, Hermanns N. Constructs of depression and distress in diabetes: Time for an appraisal. Lancet Diabetes Endocrinol 2015; 3(6): 450-60.
[http://dx.doi.org/10.1016/S2213-8587(15)00135-7] [PMID: 25995123]
[16]
Li H, Wang A, Feng W, et al. Prospective study of glycated hemoglobin and trajectories of depressive symptoms: The China health and retirement longitudinal study. Aging Dis 2019; 10(2): 249-57.
[http://dx.doi.org/10.14336/AD.2018.0410] [PMID: 31011476]
[17]
Trief PM, Foster NC, Chaytor N, et al. Longitudinal changes in depression symptoms and glycemia in adults with type 1 diabetes. Diabetes Care 2019; 42(7): 1194-201.
[http://dx.doi.org/10.2337/dc18-2441] [PMID: 31221694]
[18]
Geraets AFJ, Köhler S, Muzambi R, et al. The association of hyperglycaemia and insulin resistance with incident depressive symptoms over 4 years of follow-up: The Maastricht Study. Diabetologia 2020; 63(11): 2315-28.
[http://dx.doi.org/10.1007/s00125-020-05247-9] [PMID: 32757152]
[19]
van der Feltz-Cornelis C, Allen SF, Holt RIG, Roberts R, Nouwen A, Sartorius N. Treatment for comorbid depressive disorder or subthreshold depression in diabetes mellitus: Systematic review and meta‐analysis. Brain Behav 2021; 11(2): e01981.
[http://dx.doi.org/10.1002/brb3.1981] [PMID: 33274609]
[20]
Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ 2021; 372(71): n71.
[http://dx.doi.org/10.1136/bmj.n71] [PMID: 33782057]
[21]
Higgins JPT, Green S, Eds. Cochrane handbook for systematic reviews of interventions: Cochrane book series. (1st ed.), Chichester, UK: John Wiley & Sons, Ltd 2008.
[22]
Amsberg S, Anderbro T, Wredling R, et al. A cognitive behavior therapy-based intervention among poorly controlled adult type 1 diabetes patients—A randomized controlled trial. Patient Educ Couns 2009; 77(1): 72-80.
[http://dx.doi.org/10.1016/j.pec.2009.01.015] [PMID: 19297117]
[23]
Anderson RT, Narayan KMV, Feeney P, et al. Effect of intensive glycemic lowering on health-related quality of life in type 2 diabetes: ACCORD trial. Diabetes Care 2011; 34(4): 807-12.
[http://dx.doi.org/10.2337/dc10-1926] [PMID: 21346183]
[24]
Gerstein HC, Miller ME, Byington RP, et al. Effects of intensive glucose lowering in type 2 diabetes. N Engl J Med 2008; 358(24): 2545-59.
[http://dx.doi.org/10.1056/NEJMoa0802743] [PMID: 18539917]
[25]
Bluml BM, Kolb LE, Lipman R. Evaluating the impact of year-long, augmented diabetes self-management support. Popul Health Manag 2019; 22(6): 522-8.
[http://dx.doi.org/10.1089/pop.2018.0175] [PMID: 30668228]
[26]
Fisher L, Polonsky W, Parkin CG, Jelsovsky Z, Amstutz L, Wagner RS. The impact of blood glucose monitoring on depression and distress in insulin-naïve patients with type 2 diabetes. Curr Med Res Opin 2011; 27(sup3)(Suppl. 3): 39-46.
[http://dx.doi.org/10.1185/03007995.2011.619176] [PMID: 21916532]
[27]
Polonsky WH, Fisher L, Schikman CH, et al. Structured self-monitoring of blood glucose significantly reduces A1C levels in poorly controlled, noninsulin-treated type 2 diabetes: Results from the Structured Testing Program study. Diabetes Care 2011; 34(2): 262-7.
[http://dx.doi.org/10.2337/dc10-1732] [PMID: 21270183]
[28]
Gary TL, Baptiste-Roberts K, Crum RM, Cooper LA, Ford DE, Brancati FL. Changes in depressive symptoms and metabolic control over 3 years among African Americans with type 2 diabetes. Int J Psychiatry Med 2005; 35(4): 377-82.
[http://dx.doi.org/10.2190/BQ22-4HU0-P6EK-L7YX] [PMID: 16673837]
[29]
Gary TL, Bone LR, Hill MN, et al. Randomized controlled trial of the effects of nurse case manager and community health worker interventions on risk factors for diabetes-related complications in urban African Americans. Prev Med 2003; 37(1): 23-32.
[http://dx.doi.org/10.1016/S0091-7435(03)00040-9] [PMID: 12799126]
[30]
Khodneva Y, Safford MM, Richman J, Gamboa C, Andreae S, Cherrington A. Volunteer peer support, diabetes, and depressive symptoms: Results from the ENCOURAGE trial. J Clin Transl Endocrinol 2016; 4: 38-44.
[http://dx.doi.org/10.1016/j.jcte.2016.04.002] [PMID: 29159129]
[31]
Safford MM, Andreae S, Cherrington AL, et al. Peer coaches to improve diabetes outcomes in rural Alabama: A cluster randomized trial. Ann Fam Med 2015; 13(Suppl 1)(Suppl. 1): S18-26.
[http://dx.doi.org/10.1370/afm.1798] [PMID: 26304967]
[32]
Leyva B, Zagarins SE, Allen NA, Welch G. The relative impact of diabetes distress vs depression on glycemic control in hispanic patients following a diabetes self-management education intervention. Ethn Dis 2011; 21(3): 322-7.
[PMID: 21942165]
[33]
Welch G, Zagarins SE, Feinberg RG, Garb JL. Motivational interviewing delivered by diabetes educators: Does it improve blood glucose control among poorly controlled type 2 diabetes patients? Diabetes Res Clin Pract 2011; 91(1): 54-60.
[http://dx.doi.org/10.1016/j.diabres.2010.09.036] [PMID: 21074887]
[34]
Malanda UL, Bot SDM, Kostense PJ, Snoek FJ, Dekker JM, Nijpels G. Effects of self-monitoring of glucose on distress and self-efficacy in people with non-insulin-treated Type 2 diabetes: A randomized controlled trial. Diabet Med 2016; 33(4): 537-46.
[http://dx.doi.org/10.1111/dme.12849] [PMID: 26171942]
[35]
Presley C, Agne A, Shelton T, Oster R, Cherrington A. Mobile-enhanced peer support for african americans with Type 2 diabetes: A randomized controlled trial. J Gen Intern Med 2020; 35(10): 2889-96.
[http://dx.doi.org/10.1007/s11606-020-06011-w] [PMID: 32700215]
[36]
Rosland AM, Kieffer E, Spencer M, et al. Do pre-existing diabetes social support or depressive symptoms influence the effectiveness of a diabetes management intervention? Patient Educ Couns 2015; 98(11): 1402-9.
[http://dx.doi.org/10.1016/j.pec.2015.05.019] [PMID: 26234800]
[37]
Spencer MS, Rosland AM, Kieffer EC, et al. Effectiveness of a community health worker intervention among African American and Latino adults with type 2 diabetes: A randomized controlled trial. Am J Public Health 2011; 101(12): 2253-60.
[http://dx.doi.org/10.2105/AJPH.2010.300106] [PMID: 21680932]
[38]
der Ven NCW, Hogenelst MHE, Tromp-Wever AME, et al. Short-term effects of cognitive behavioural group training (CBGT) in adult Type 1 diabetes patients in prolonged poor glycaemic control. A randomized controlled trial. Diabet Med 2005; 22(11): 1619-23.
[http://dx.doi.org/10.1111/j.1464-5491.2005.01691.x] [PMID: 16241932]
[39]
Wang ML, Lemon SC, Whited MC, Rosal MC. Who benefits from diabetes self-management interventions? The influence of depression in the Latinos en Control trial. Ann Behav Med 2014; 48(2): 256-64.
[http://dx.doi.org/10.1007/s12160-014-9606-y] [PMID: 24664615]
[40]
Rosal MC, Ockene IS, Restrepo A, et al. Randomized trial of a literacy-sensitive, culturally tailored diabetes self-management intervention for low-income latinos: Latinos en control. Diabetes Care 2011; 34(4): 838-44.
[http://dx.doi.org/10.2337/dc10-1981] [PMID: 21378213]
[41]
Beran M, Muzambi R, Geraets A, et al. The bidirectional longitudinal association between depressive symptoms and HbA 1c: A systematic review and meta‐analysis. Diabet Med 2022; 39(2): e14671.
[http://dx.doi.org/10.1111/dme.14671] [PMID: 34407250]
[42]
van Agtmaal MJM, Houben AJHM, Pouwer F, Stehouwer CDA, Schram MT. Association of microvascular dysfunction with late-life depression: A systematic review and meta-analysis. JAMA Psychiatry 2017; 74(7): 729-39.
[http://dx.doi.org/10.1001/jamapsychiatry.2017.0984] [PMID: 28564681]
[43]
Moulton CD, Pickup JC, Ismail K. The link between depression and diabetes: The search for shared mechanisms. Lancet Diabetes Endocrinol 2015; 3(6): 461-71.
[http://dx.doi.org/10.1016/S2213-8587(15)00134-5] [PMID: 25995124]
[44]
Van Sloten T, Schram M. Understanding depression in type 2 diabetes: A biological approach in observational studies. F1000 Res 2018; 7: 1283.
[45]
Lloyd CE, Sartorius N, Ahmed HU, et al. Factors associated with the onset of major depressive disorder in adults with type 2 diabetes living in 12 different countries: Results from the INTERPRET-DD prospective study. Epidemiol Psychiatr Sci 2020; 29(e134): e134.
[http://dx.doi.org/10.1017/S2045796020000438] [PMID: 32484148]
[46]
Fisher L, Gonzalez JS, Polonsky WH. The confusing tale of depression and distress in patients with diabetes: A call for greater clarity and precision. Diabet Med 2014; 31(7): 764-72.
[http://dx.doi.org/10.1111/dme.12428] [PMID: 24606397]

Rights & Permissions Print Cite
© 2024 Bentham Science Publishers | Privacy Policy