Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2021 Feb;11(2):e01981.
doi: 10.1002/brb3.1981. Epub 2020 Dec 4.

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

Christina van der Feltz-Cornelis  1 , Sarah F Allen  1 , Richard I G Holt  2 , Richard Roberts  3 , Arie Nouwen  4 , Norman Sartorius  5
Affiliations
Meta-Analysis

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

Christina van der Feltz-Cornelis et al. Brain Behav. 2021 Feb.

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.

PubMed Disclaimer

Conflict of interest statement

Over the last three years, RIGH has received honoraria for speaker engagement, conference attendance, or advisory boards from AstraZeneca, Boehringer Ingelheim, European Association for the Study of Diabetes, Eli Lilly, Janssen, Menarini, Mylan, Novo Nordisk, OmniaMed, and Otsuka. AN has received funding for lectures from OmniaMed, and, as Chairperson of the Psycho‐Social Aspects of Diabetes (PSAD) study group of the European Association for the Study of Diabetes, funding for travel Fellowships for early career researchers from Sanofi. The other authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Map of the world showing the location of each study included in the review
Figure 2
Figure 2
Forest plot showing results of meta‐analysis of studies of depressive disorder with depression as outcome, grouped by treatment. CBT = cognitive behavioral therapy; BA = behavioral activation; EX = add‐on exercise; PT = psychological treatment (counseling); SPT = supportive psychotherapy
Figure 3
Figure 3
Forest plot showing results of meta‐analysis of studies of depressive disorder on glycemic control grouped by treatment. CBT = cognitive behavioral therapy; BA = behavioral activation; EX = add‐on exercise PT = psychological treatment (counseling)
Figure 4
Figure 4
Flowchart showing treatment recommendations for comorbid depression in diabetes
See this image and copyright information in PMC

References

    1. Arteaga‐Henríquez, G. , Simon, M. S. , Burger, B. , Weidinger, E. , Wijkhuijs, A. , Arolt, V. , Birkenhager, T. K. , Musli, R. , Müller, N. , & Drexhage, H. A. (2019). Low‐grade inflammation as a predictor of antidepressant and anti‐inflammatory therapy response in MDD patients: A systematic review of the literature in combination with an analysis of experimental data collected in the EU‐Moodinflame consortium. Frontiers Psychiatry, 10 10.3389/fpsyt.2019.00458 - DOI - PMC - PubMed
    1. Atlantis, E. , Fahey, P. , & Foster, J. (2014). Collaborative care for comorbid depression and diabetes: A systematic review and meta‐analysis. British Medical Journal Open, 4(4), e004706. - PMC - PubMed
    1. Barragán‐Rodríguez, L. , Rodríguez‐Morán, M. , & Guerrero‐Romero, F. (2008). Efficacy and safety of oral magnesium supplementation in the treatment of depression in the elderly with type 2 diabetes: A randomized, equivalent trial. Magnesium Research, 21(4), 218–223. - PubMed
    1. Baumeister, H. H. N. , & Bengel, J. (2012) Psychological and pharmacological interventions for depression in patients with diabetes mellitus and depression. Cochrane Database of Systematic Reviews (Online), 12, CD008381. - PMC - PubMed
    1. Baumeister, H. , Hutter, N. , & Bengel, J. (2014). Psychological and pharmacological interventions for depression in patients with diabetes mellitus: An abridged Cochrane review. Diabetic Medicine, 31(7), 773–786. - PubMed

Publication types

MeSH terms