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

  • Authors: Schmitt A.1,2, Beran M.3,4, Geraets A.3,5, Iversen M.6, Nefs G.7,8,9, Nouwen A.10,11, Pouwer F.12,13, Huber J.14, Schram M.3,5,15
  • Affiliations:
    1. Research Institute Diabetes Academy Mergentheim (FIDAM), Diabetes Center Mergentheim (DZM), Johann-Hammer- Straße 24, 97980 Bad Mergentheim, Germany
    2. German Center for Diabetes Research (DZD), Ingolstädter Landstraße 1, 85764, Oberschleißheim, Germany
    3. Department of Internal Medicine, School for Cardiovascular Diseases (CARIM), Maastricht University, Universiteitssingel 50, 6229 ER Maastricht, The Netherlands
    4. Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Universiteitsweg 100, 3584 CG Utrecht, The Netherlands
    5. Department of Psychiatry and Neuropsychology, MHeNs School for Mental Health and Neuroscience, Maastricht University, Universiteitssingel 40, 6229 ER Maastricht, The Netherlands
    6. Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Inndalsveien 28, 5063 Bergen, Norway
    7. Department of Medical and Clinical Psychology, Center of Research on Psychological and Somatic Disorders (CoRPS), Tilburg University, Warandelaan 2, 5037 AB Tilburg, The Netherlands
    8. Department of Medical Psychology, Radboud Institute for Health Sciences, Radboud University Medical Center, Geert Grooteplein 27, 6525 EZ Nijmegen, The Netherlands
    9. Diabeter, National Treatment and Research Center for Children, Adolescents and Young Adults with Type 1 Diabetes, Blaak 6, 3011 TA Rotterdam, The Netherlands
    10. Department of Psychology, Middlesex University London, The Burroughs, London NW4 4BT, United Kingdom
    11. School of Health, Wellbeing and Social Care, The Open University, Walton Hall, Milton Keynes MK7 6AA, United Kingdom
    12. Department of Psychology, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark
    13. Steno Diabetes Center Odense (SDCO), Odense University Hospital, J. B. Winsløws Vej 4, 5000 Odense C, Denmark
    14. School of Sport and Health Sciences, University of Brighton, Westlain House, Brighton BN1 9PH, United Kingdom
    15. Heart and Vascular Centre, Maastricht University Medical Center, Professor Debyelaan 25, 6229HX Maastricht, The Netherlands
  • Issue: Vol 20, No 3 (2024)
  • Section: Medicine
  • URL: https://vestnik.nvsu.ru/1573-3998/article/view/642976
  • DOI: https://doi.org/10.2174/1573399820666230602124223
  • ID: 642976

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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 wap <0.0% (<64mmol/mol) in two, 8.0–9.0% (64–75mmol/mol) in eight, and ≥10.0% (≥86mmol/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.

About the authors

Andreas Schmitt

Research Institute Diabetes Academy Mergentheim (FIDAM), Diabetes Center Mergentheim (DZM), Johann-Hammer-
Straße 24, 97980 Bad Mergentheim, Germany; German Center for Diabetes Research (DZD), Ingolstädter Landstraße
1, 85764, Oberschleißheim, Germany

Email: info@benthamscience.net

Magdalena Beran

Department of Internal Medicine, School for Cardiovascular Diseases (CARIM),
Maastricht University, Universiteitssingel 50, 6229 ER Maastricht, The Netherlands; Department of Epidemiology,
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Universiteitsweg 100, 3584
CG Utrecht, The Netherlands

Email: info@benthamscience.net

Anouk Geraets

Department of Internal Medicine, School for Cardiovascular Diseases (CARIM),
Maastricht University, Universiteitssingel 50, 6229 ER Maastricht, The Netherlands; Department of Psychiatry and Neuropsychology, MHeNs School for Mental Health and
Neuroscience, Maastricht University, Universiteitssingel 40, 6229 ER Maastricht, The Netherlands

Email: info@benthamscience.net

Marjolein Iversen

Faculty of Health
and Social Sciences, Western Norway University of Applied Sciences, Inndalsveien 28, 5063 Bergen, Norway

Email: info@benthamscience.net

Giesje Nefs

Department of Medical and Clinical Psychology, Center of Research on Psychological and Somatic Disorders
(CoRPS), Tilburg University, Warandelaan 2, 5037 AB Tilburg, The Netherlands; Department of Medical Psychology,
Radboud Institute for Health Sciences, Radboud University Medical Center, Geert Grooteplein 27, 6525 EZ Nijmegen,
The Netherlands; Diabeter, National Treatment and Research Center for Children, Adolescents and Young Adults with
Type 1 Diabetes, Blaak 6, 3011 TA Rotterdam, The Netherlands

Email: info@benthamscience.net

Arie Nouwen

Department of Psychology, Middlesex University
London, The Burroughs, London NW4 4BT, United Kingdom; School of Health, Wellbeing and Social Care, The Open
University, Walton Hall, Milton Keynes MK7 6AA, United Kingdom

Email: info@benthamscience.net

Frans Pouwer

Department of Psychology, University of Southern
Denmark, Campusvej 55, 5230 Odense M, Denmark; Steno Diabetes Center Odense (SDCO), Odense University
Hospital, J. B. Winsløws Vej 4, 5000 Odense C, Denmark

Email: info@benthamscience.net

Jörg Huber

School of Sport and Health Sciences, University of Brighton,
Westlain House, Brighton BN1 9PH, United Kingdom

Email: info@benthamscience.net

Miranda Schram

Department of Internal Medicine, School for Cardiovascular Diseases (CARIM),
Maastricht University, Universiteitssingel 50, 6229 ER Maastricht, The Netherlands; Department of Psychiatry and Neuropsychology, MHeNs School for Mental Health and
Neuroscience, Maastricht University, Universiteitssingel 40, 6229 ER Maastricht, The Netherlands; Heart and Vascular Centre, Maastricht University Medical
Center, Professor Debyelaan 25, 6229HX Maastricht, The Netherlands

Author for correspondence.
Email: info@benthamscience.net

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