Comorbid diabetes and depression: do E-health treatments achieve better diabetes control?

Abstract

SUMMARYResearch in the field of comorbid depression in diabetes shows that the optimum treatment to attain better diabetes disease control is still undecided. Although several treatment models are effective and available, interventions aimed at improving disease control, such as glycemic control, are less effective, with moderate evidence for pharmacological treatment and a lot of evidence for psychotherapy in combination with self-management techniques. New developments such as M-health and E-health are much less effective and show much less effect in terms of glycemic control than earlier developed, face-to-face psychotherapeutic treatments, and demonstrate higher mortality rates in patients with diabetes mellitus or with multimorbidity, which gives reason for caution in the evaluation, testing and implementation of E-health and M-health models in patients with diabetes and depression. Further research into blended E-health models, in which the clinical diagnostic and treatment evaluation is strongly embedded, and with a focus not only on depression treatment, but also on diabetes control and taking mortality into account as outcome, is needed. Treatment of comorbid depression in diabetes mellitus is effective in achieving improvement of depression outcomes, with the largest effects seen for psychotherapy and pharmacotherapy.However, treatment effects are inconclusive or small in terms of diabetes control; the effects of face-to-face psychotherapeutic treatment and pharmacotherapy are largest.Treatment with E-health and M-health so far shows disappointing results. Effects on diabetes control are small to nil, and mortality rates may be higher, demonstrating that newer treatments are not always better.Claims of cost-effectiveness of E-health so far have not been substantiated for this kind of treatment either and there is no basis for grand-scale implementation of E-health or M-health at the moment.Future research should be aimed at interventions combining depression treatment with treatment specifically aimed at diabetes control, taking into account not only glycemic control, but also complications and mortality, in patients with depression and diabetes.Future research should evaluate blended models combining E-health with clinical care, which may have the best potential.

NIDDK International Conference Report on Diabetes and Depression: Current Understanding and Future Directions

“…A total of eight randomized controlled trials have evaluated the efficacy of psychotherapeutic interventions on depression in mixed populations of adults with type 1 and type 2 diabetes. Similar beneficial effects of low to moderate effect size have been observed across the studies, indicating the value of this approach in the context of multiple variations in length and format of delivery (e.g., eHealth, individual face-to-face psychotherapy, group psychotherapy) and audience ( 55 ). Further research is needed to improve the efficacy of CBT and determine the minimum meaningful “dose” needed to have the greatest cost-benefit for people with diabetes and health providers.…”

“…For example, trials of eHealth and mobile technology–based health (mHealth) interventions suggest that these are less effective than face-to-face psychotherapeutic treatments (55). …”

“…Although a small research base exists, more research is needed to test alternative behavioral intervention approaches for treating diabetes and depression (e.g., electronic-based health [eHealth] intervention, exercise, mindfulness-based stress reduction). For example, trials of eHealth and mobile technology–based health (mHealth) interventions suggest that these are less effective than face-to-face psychotherapeutic treatments ( 55 ).…”

Effect of motivational interviewing intervention on HgbA1C and depression in people with type 2 diabetes mellitus (systematic review and meta-analysis)

“…The result indicated that depressive symptoms were not significantly lower in the intervention group when compared with control group. However, evidence indicated that psychological therapies like Motivational Interviewing (MI) may also be effective in treating depression in people with diabetes but may have limited effects on glycemic outcomes [ 47 , 48 ]. Two possible reasons for these findings may be considered.…”

Diabetes and Depression

“…The trials have a preponderance of people with type 2 diabetes and no trials have been conducted to date with only people with type 1 diabetes. There is preliminary evidence to suggest the web-based psychological therapies may also be effective in treating depression in people with diabetes but may have limited effects on glycemic outcomes [76, 77]. …”