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Psychological and pharmacological interventions for depression in patients with diabetes mellitus: an abridged Cochrane review.
Diabet Med. 2014 Jul; 31(7):773-86.DM

Abstract

AIMS

To summarize and critically evaluate the effectiveness of psychological and pharmacological interventions for depression in patients with both diabetes and depression.

METHODS

Randomized controlled trials investigating psychological and pharmacological interventions for depression in adults with diabetes and depression were included. A comprehensive search of primary studies according to Cochrane were conducted. Primary outcomes were depression and glycaemic control. Further, treatment adherence, diabetes complications, mortality, healthcare costs and quality of life were investigated. Two reviewers identified primary studies and extracted data independently. Random-effects model meta-analyses were conducted to compute overall estimates of treatment outcomes.

RESULTS

The database search resulted in 3963 references, of which 19 trials were included. Randomized controlled trials of psychological interventions showed positive effects on short- and medium-term depression severity [standardized mean difference short-term range -1.47; -0.14, n = 7; medium-term standardized mean difference -0.42 (95% CI -0.70 to -0.14), n = 3] and depression remission [odds ratio short term 2.88 (95% CI 1.58-5.25), n = 4; odds ratio medium term 2.49 (95% CI 1.44-4.32), n = 2]. Effects on glycaemic control in psychological intervention trials varied substantially (standardized mean difference range -0.97 to 0.47, n = 4). Selective serotonin reuptake inhibitors showed a moderate beneficial effect on short-term depression severity [standardized mean difference -0.39 (95% CI -0.64 to -0.13], n = 5) and depression remission [odds ratio 2.52 (95% CI 1.11-5.75), n = 2]. Glycaemic control improved in randomized controlled trials comparing selective serotonin reuptake inhibitors with placebo at the end of treatment [standardized mean difference -0.38 (95% CI -0.64 to -0.12), n = 5].

CONCLUSIONS

Psychological and pharmacological interventions positively affect depression outcomes in patients with diabetes at the end of treatment. Furthermore, short-term glycaemic control improved moderately in pharmacological trials. Most outcomes have not been investigated sufficiently. Moreover, there is a lack of follow-up data for pharmacological trials limiting the evidence on the sustainability of treatment effects.

Authors+Show Affiliations

Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg; Medical Psychology and Medical Sociology, University of Freiburg, Medical Faculty, Freiburg, Germany.No affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Meta-Analysis
Research Support, Non-U.S. Gov't
Review

Language

eng

PubMed ID

24673571

Citation

Baumeister, H, et al. "Psychological and Pharmacological Interventions for Depression in Patients With Diabetes Mellitus: an Abridged Cochrane Review." Diabetic Medicine : a Journal of the British Diabetic Association, vol. 31, no. 7, 2014, pp. 773-86.
Baumeister H, Hutter N, Bengel J. Psychological and pharmacological interventions for depression in patients with diabetes mellitus: an abridged Cochrane review. Diabet Med. 2014;31(7):773-86.
Baumeister, H., Hutter, N., & Bengel, J. (2014). Psychological and pharmacological interventions for depression in patients with diabetes mellitus: an abridged Cochrane review. Diabetic Medicine : a Journal of the British Diabetic Association, 31(7), 773-86. https://doi.org/10.1111/dme.12452
Baumeister H, Hutter N, Bengel J. Psychological and Pharmacological Interventions for Depression in Patients With Diabetes Mellitus: an Abridged Cochrane Review. Diabet Med. 2014;31(7):773-86. PubMed PMID: 24673571.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Psychological and pharmacological interventions for depression in patients with diabetes mellitus: an abridged Cochrane review. AU - Baumeister,H, AU - Hutter,N, AU - Bengel,J, PY - 2013/09/10/received PY - 2013/11/29/revised PY - 2014/03/21/accepted PY - 2014/3/29/entrez PY - 2014/3/29/pubmed PY - 2015/3/31/medline SP - 773 EP - 86 JF - Diabetic medicine : a journal of the British Diabetic Association JO - Diabet. Med. VL - 31 IS - 7 N2 - AIMS: To summarize and critically evaluate the effectiveness of psychological and pharmacological interventions for depression in patients with both diabetes and depression. METHODS: Randomized controlled trials investigating psychological and pharmacological interventions for depression in adults with diabetes and depression were included. A comprehensive search of primary studies according to Cochrane were conducted. Primary outcomes were depression and glycaemic control. Further, treatment adherence, diabetes complications, mortality, healthcare costs and quality of life were investigated. Two reviewers identified primary studies and extracted data independently. Random-effects model meta-analyses were conducted to compute overall estimates of treatment outcomes. RESULTS: The database search resulted in 3963 references, of which 19 trials were included. Randomized controlled trials of psychological interventions showed positive effects on short- and medium-term depression severity [standardized mean difference short-term range -1.47; -0.14, n = 7; medium-term standardized mean difference -0.42 (95% CI -0.70 to -0.14), n = 3] and depression remission [odds ratio short term 2.88 (95% CI 1.58-5.25), n = 4; odds ratio medium term 2.49 (95% CI 1.44-4.32), n = 2]. Effects on glycaemic control in psychological intervention trials varied substantially (standardized mean difference range -0.97 to 0.47, n = 4). Selective serotonin reuptake inhibitors showed a moderate beneficial effect on short-term depression severity [standardized mean difference -0.39 (95% CI -0.64 to -0.13], n = 5) and depression remission [odds ratio 2.52 (95% CI 1.11-5.75), n = 2]. Glycaemic control improved in randomized controlled trials comparing selective serotonin reuptake inhibitors with placebo at the end of treatment [standardized mean difference -0.38 (95% CI -0.64 to -0.12), n = 5]. CONCLUSIONS: Psychological and pharmacological interventions positively affect depression outcomes in patients with diabetes at the end of treatment. Furthermore, short-term glycaemic control improved moderately in pharmacological trials. Most outcomes have not been investigated sufficiently. Moreover, there is a lack of follow-up data for pharmacological trials limiting the evidence on the sustainability of treatment effects. SN - 1464-5491 UR - https://www.unboundmedicine.com/medline/citation/24673571/Psychological_and_pharmacological_interventions_for_depression_in_patients_with_diabetes_mellitus:_an_abridged_Cochrane_review_ L2 - https://doi.org/10.1111/dme.12452 DB - PRIME DP - Unbound Medicine ER -