Associations between HbA1c reduction and change in depressive symptoms following glucose-lowering treatment in adults: A systematic review of intervention studies

Article

Schmitt, A., Beran, M., Geraets, A., Iversen, M., Nefs, G., Nouwen, A., Pouwer, F., Huber, J. and T Schram, M. 2024. Associations between HbA1c reduction and change in depressive symptoms following glucose-lowering treatment in adults: A systematic review of intervention studies. Current Diabetes Reviews. 20 (3), pp. 66-83. https://doi.org/10.2174/1573399820666230602124223
TypeArticle
TitleAssociations between HbA1c reduction and change in depressive symptoms following glucose-lowering treatment in adults: A systematic review of intervention studies
AuthorsSchmitt, A., Beran, M., Geraets, A., Iversen, M., Nefs, G., Nouwen, A., Pouwer, F., Huber, J. and T Schram, M.
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 A1C (HbA1c)-lowering interventions with depressive symptoms.
Methods: PubMed, PsycINFO, CINAHL, and EMBASE databases were searched for randomized controlled trials evaluating A1C-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 was <8.0% (<64mmol/mol) in two, 8.0–9.0% (64–75mmol/mol) in eight, and ≥10.0% (≥86mmol/mol) in two studies. Of five studies that found greater HbA1c reduction in the treatment group, three also 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.

KeywordsHbA1c; systematic review; depressive symptoms; Diabetes mellitus; intervention; randomized controlled trial
Sustainable Development Goals3 Good health and well-being
Middlesex University ThemeHealth & Wellbeing
PublisherBentham Science Publishers
JournalCurrent Diabetes Reviews
ISSN1573-3998
Electronic1875-6417
Publication dates
Online16 Aug 2023
PrintMar 2024
Publication process dates
Submitted07 Nov 2022
Accepted03 May 2023
Deposited15 Jun 2023
Output statusPublished
Accepted author manuscript
File Access Level
Open
Copyright Statement

The full text deposited is the accepted author manuscript.
The published manuscript is available at EurekaSelect via http://www.eurekaselect.com/article/132256

Digital Object Identifier (DOI)https://doi.org/10.2174/1573399820666230602124223
PubMed ID37278034
LanguageEnglish
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