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A Systematic Review and Meta-analysis of the Association Between Depression and Insulin Resistance

Kan, Carol, Silva, Naomi, Golden, Sherita Hill, Rajala, Ulla, Timonen, Markku, Stahl, Daniel, Ismail, Khalida·2013·Diabetes Care
DOI 10.2337/dc12-1442PMC PMC3554272
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Abstract

OBJECTIVE: Depression is associated with the onset of type 2 diabetes. A systematic review and meta-analysis of observational studies, controlled trials, and unpublished data was conducted to examine the association between depression and insulin resistance (IR). RESEARCH DESIGN AND METHODS: Medline, EMBASE, and PsycINFO were searched for studies published up to September 2011. Two independent reviewers assessed the eligibility of each report based on predefined inclusion criteria (study design and measure of depression and IR, excluding prevalent cases of diabetes). Individual effect sizes were standardized, and a meta-analysis was performed to calculate a pooled effect size using random effects. Subgroup analyses and meta-regression were conducted to explore any potential source of heterogeneity between studies. RESULTS: Of 967 abstracts reviewed, 21 studies met the inclusion criteria of which 18 studies had appropriate data for the meta-analysis (n = 25,847). The pooled effect size (95% CI) was 0.19 (0.11–0.27) with marked heterogeneity (I2 = 82.2%) using the random-effects model. Heterogeneity between studies was not explained by age or sex, but could be partly explained by the methods of depression and IR assessments. CONCLUSIONS: A small but significant cross-sectional association was observed between depression and IR, despite heterogeneity between studies. The pathophysiology mechanisms and direction of this association need further study using a purposively designed prospective or intervention study in samples at high risk for diabetes.

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Figure 1 Flowchart of systematic review. *Further information in regards to excluded studies can be found in Supplementary Table 1.
Figure 1 Flowchart of systematic review. *Further information in regards to excluded studies can be found in Supplementary Table 1.CC BY-NC-ND · PubMed Central
Figure 2 Forest plots showing the effect size of the association between depression and insulin resistance. Estimates are at the center of the boxes and drawn in proportion to the SEs. Lines indicate 95% CIs. Diamond shows the pooled effect size at its center and 95% CI at its horizontal points. IGT, impaired glucose tolerance; NGT, normal glucose tolerance.
Figure 2 Forest plots showing the effect size of the association between depression and insulin resistance. Estimates are at the center of the boxes and drawn in proportion to the SEs. Lines indicate 95% CIs. Diamond shows the pooled effect size at its center and 95% CI at its horizontal points. IGT, impaired glucose tolerance; NGT, normal glucose tolerance.CC BY-NC-ND · PubMed Central
Figure 3 Forest plots of the unadjusted and adjusted association between depression and insulin resistance for studies with confounders included. Confounders adjusted for A: age, ethnicity, waist circumference, education, physical activity, antidepressants, medications for nervous conditions, site; B: age, sex, ethnicity, BMI; C: weight, BMI, waist-to-hip ratio; D: weight, BMI, waist-to-hip ratio; E: age, sex, BMI, comorbidity, education, physical activity, smoking, alcohol, geographical location, residential region; F: age, education, physical activity, smoking, alcohol, antidepressants, fish consumption; G: age, education, physical activity, smoking, alcohol, antidepressants, oral contraceptives, fish consumption, polycystic ovary disease; H: age, ethnicity, waist circumference, smoking, systolic blood pressure, triglyceride; I: age, ethnicity, waist circumference, smoking, systolic blood pressure, triglyceride; J: sex, BMI, education, physical inactivity, smoking, alcohol; K: sex, BMI, education, physical inactivity, smoking, alcohol; L: BMI, comorbidity, socioeconomic status, physical inactivity, smoking, alcohol, C-reactive protein, cholesterol level; M: BMI, comorbidity, socioeconomic status, physical inactivity, smoking, alcohol, C-reactive protein, cholesterol level; and N: waist circumference, education, physical inactivity, alcohol, smoking. IGT, impaired glucose tolerance; NGT, normal glucose tolerance.
Figure 3 Forest plots of the unadjusted and adjusted association between depression and insulin resistance for studies with confounders included. Confounders adjusted for A: age, ethnicity, waist circumference, education, physical activity, antidepressants, medications for nervous conditions, site; B: age, sex, ethnicity, BMI; C: weight, BMI, waist-to-hip ratio; D: weight, BMI, waist-to-hip ratio; E: age, sex, BMI, comorbidity, education, physical activity, smoking, alcohol, geographical location, residential region; F: age, education, physical activity, smoking, alcohol, antidepressants, fish consumption; G: age, education, physical activity, smoking, alcohol, antidepressants, oral contraceptives, fish consumption, polycystic ovary disease; H: age, ethnicity, waist circumference, smoking, systolic blood pressure, triglyceride; I: age, ethnicity, waist circumference, smoking, systolic blood pressure, triglyceride; J: sex, BMI, education, physical inactivity, smoking, alcohol; K: sex, BMI, education, physical inactivity, smoking, alcohol; L: BMI, comorbidity, socioeconomic status, physical inactivity, smoking, alcohol, C-reactive protein, cholesterol level; M: BMI, comorbidity, socioeconomic status, physical inactivity, smoking, alcohol, C-reactive protein, cholesterol level; and N: waist circumference, education, physical inactivity, alcohol, smoking. IGT, impaired glucose tolerance; NGT, normal glucose tolerance.CC BY-NC-ND · PubMed Central

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Citations

Cites

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Metadata

Authors
Kan, C., Silva, N., Golden, S. H., Rajala, U., Timonen, M., Stahl, D., & Ismail, K.
Affiliations
  • Institute of Psychiatry, King’s College London, London, U.K.
  • Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
  • Institute of Health Sciences, University of Oulu, Oulu, Finland
  • Department of Biostatistics, Institute of Psychiatry, King’s College London, London, U.K.
Venue
Diabetes Care
Publisher
American Diabetes Association
Published
2013-01-17
Volume
36
Issue
2
Pages
480-489
ISSN
  • 0149-5992
  • 1935-5548
DOI
10.2337/dc12-1442
PMC
PMC3554272
Cited by
322
References
16
Language
en
Licence
creativecommons.org/licenses/by-nc-nd/3.0/ (vor, 3149 d)

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