Treatment for comorbid depressive disorder or subthreshold depression in diabetes mellitus: systematic review and meta‐analysis
Open accessAbstract
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.
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Their effect on physical health varies depending on the specific condition.
“Their effect on physical health, however, varies depending on the specific condition292,369.”
From Comorbidity between major depressive disorder and physical diseases: a comprehensive review of epidemiology, mechanisms and management (2023) · cites this paper as [292]
The Results and Discussion report that treatments differ in their effects on glycemic control, a physical-health outcome in people with diabetes. They do not compare effects across different physical conditions, so they do not support the claim that the effect varies depending on the specific condition. Page numbers are unavailable in our copy. (LLM, conf=0.83)
Experimental — accuracy not yet measuredCollaborative care interventions have shown positive effects for people with depressive symptoms and coronary heart disease, breast cancer, and diabetes mellitus.
“Collaborative care interventions have shown positive effects for people with depressive symptoms and coronary heart disease366, breast cancer367, and diabetes mellitus292,364.”
From Comorbidity between major depressive disorder and physical diseases: a comprehensive review of epidemiology, mechanisms and management (2023) · cites this paper as [292]
Among individuals with diabetes mellitus, antidepressant treatment is reported by RCTs to improve glycemic control.
“Among individuals with diabetes mellitus, antidepressant treatment is reported by RCTs to improve glycemic control292”
From Comorbidity between major depressive disorder and physical diseases: a comprehensive review of epidemiology, mechanisms and management (2023) · cites this paper as [292]
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Franquez, R. T., Silva, M. T., & Bergamaschi, C. D. C. (2022) · Farmacoterapêutica · doi:10.14450/2763-7654.v25.e3.a2021.pp5-13
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Kapfhammer, H. (2022) · Springer eBooks · doi:10.1007/978-3-662-65873-4_4
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Zambelli, R. A. (2022) · Current Research in Diabetes & Obesity Journal · doi:10.19080/crdoj.2022.16.555935
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- Authors
- van der Feltz‐Cornelis, C., Allen, S. F., Holt, R. I. G., Roberts, R., Nouwen, A., & Sartorius, N.
- Affiliations
- Department of Health Sciences Hull York Medical School University of York York UK
- University of York (GB)
- University of Southampton (GB)
- University of Wisconsin–Madison (US)
- Middlesex University London (GB)
- Association for the Improvement of Mental Health Programmes Geneva Switzerland
- ORCID
- Venue
- Brain and Behavior
- Publisher
- Wiley
- Published
- 2020-12-04
- Volume
- 11
- Issue
- 2
- Pages
- e01981-e01981
- ISSN
- 2157-9032 (ISSN-L)
- 2162-3279
- PMC
- PMC7882189
- OpenAlex
- W3104126735
- Cited by
- 130
- References
- 100
- Citations by year
- 2026: 16 · 2025: 26 · 2024: 27 · 2023: 31 · 2022: 25 · 2021: 4 · 2020: 1
- FWCI
- 2.33
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Brain and Behavior (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Teesside University Research Portal (Teesside University) (publishedVersion, cc-by)
- TeesRep (Teesside University) (publishedVersion, cc-by)
- Middlesex University Research Repository (Middlesex University Of London) (acceptedVersion)
- White Rose Research Online (University of Leeds, The University of Sheffield, University of York) (acceptedVersion)
- Northumbria Research Link (Northumbria University) (acceptedVersion)
- ePrints Soton (University of Southampton) (acceptedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Keywords
- depression, diabetes mellitus, type 1 diabetes, type 2 diabetes, comorbidities, subthreshold depression, depressive disorders, glycemic control, HbA1c, antidepressant treatment, psychotherapy, group therapy, collaborative care, physical activity, online therapy, baseline depression severity, baseline HbA1c
- MeSH terms
- Depression, Depressive Disorder, Diabetes Mellitus, Type 1, Humans, Psychotherapy, Psychotherapy, Group, Randomized Controlled Trials as Topic
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