Depression and poor glycemic control: a meta-analytic review of the literature.

Abstract

Hyperglycemia has been linked to the development of diabetic complications (1). Treatments that lower blood glucose levels reduce the risks of retinopathy, neuropathy, and nephropathy in patients with type 1 (2,3) or type 2 (4,5) diabetes. Accordingly, maintenance of good glycemic control is the focus of diabetes therapy, and the importance of other clinical factors is judged largely in relation to their effects on this parameter.Clinical and subclinical expressions of depression are present in Ͼ25% of patients with type 1 or type 2 diabetes (6-14) and have adverse effects on functioning and quality of life (15,16). The existing literature is not consistent and clear with regard to the association between depression and poor glycemic control. Such an association would suggest the possibility that depression treatment might have favorable effects on diabetic outcomes. We surveyed the scientific literature, identified studies that measured the association of depression (either by symptoms or the diagnosis) with glycemic control, and performed a metaanalysis to assess the reliability and strength of any association. RESEARCH DESIGN ANDMETHODS -Medline and PsycINFO were used to locate studies published in the last 25 years that reported the association of depression with glycemic control in adult diabetic subjects. The reference lists of these articles were examined to identify additional studies, and this led to the consideration of several unpublished papers and manuscripts. Inclusion and exclusion criteriaStudies were limited to adult participants (Ն18 years of age), to those that assessed glycemic control using a measure of glycohemoglobin (denoted as GHb within this article) (17,18), and to those that measured depression and GHb coincident to the study evaluation. Studies with Ͻ25 patients, those neither published nor available in English, and those that ascertained only a history of depression were excluded. Subjects in the included studies were patients diagnosed with type 1 or type 2 diabetes; studies of subjects with impaired glucose tolerance, borderline diabetes, or gestational diabetes were not considered. Studies were included without regard to the way the depression-glycemic control association was tested. In some studies, depression was the independent variable and glycemic control the dependent variable. Other studies used the reverse approach, and some reported only the correlation between the 2 variables.Study procedures and statistical analysis Study characteristics were recorded, and the studies were categorized by methodology. Type of diabetes and method of depression assessment were recorded, and effect sizes (ESs) were examined in relation to these factors. The diagnosis of depression (major depressive disorder) was established by using structured or semistructured clinical interviews and the diagnostic criteria in use at the time of the study (e.g., American Psychiatric Association' s Diagnostic and Statistical Manual of Mental Disorders [19,20] Depression and Poor Glycemic ControlA meta-an...

Elucidating the Association Between Depressive Symptoms, Coronary Heart Disease, and Stroke in Black and White Adults: The REasons for Geographic And Racial Differences in Stroke (REGARDS) Study

“…Depressive symptoms have been shown to be associated with smoking,28 medication noncompliance,29 and physical inactivity30 as well as diabetes,31 obesity,32 hypertension,33 and inflammation 34. We added to the literature by demonstrating that these factors and others such as antidepressant use35 and corrected QT interval36 do not appear to fully explain the association between depressive symptoms and incident CVD death and stroke in otherwise healthy persons.…”

Association between depression and glycemic control among type 2 diabetes patients in Lima, Peru

“…There are several cross‐sectional studies reporting that depression is a factor associated with poor glycemic control among patients with T2D (Lustman et al ., 2000; Lustman and Clouse, 2005; Papelbaum et al ., 2011; Zhang et al ., 2014). Our results are consistent with these findings even after controlling for a large list of potential confounders; our hierarchical approach is reassuring, suggesting that the impact of covariates is not considerable in the proposed association as estimates remain roughly constant in the different models.…”

“…Regarding mental health, the presence of depressive symptoms has been also proposed as a potential factor associated with poor glycemic control (Lustman et al ., 2000; Fisher et al ., 2010; Heckbert et al ., 2010). Although a bidirectional relationship of depression and diabetes has been proposed (Golden et al ., 2008), the prevalence of depression among patients with T2D is relatively high when compared with the general population (Anderson et al ., 2001; Lustman and Clouse, 2005; Zhang et al ., 2014), but there is limited and controversial information regarding the potential impact of depression on glycemic control.…”

Keys to Successful Diabetes Self-management for Uninsured Patients: Social Support, Observational Learning, and Turning Points: A Safety Net Providers' Strategic Alliance Study

“…Each chronic condition potentially complicated diabetes management, burdened the patient psychologically and financially, and may have contributed to reducing motivation for self-management. 40,41 The most common co-morbidity for unsuccessful patients was depression, which has been associated with poor glycemic control 42 and non-adherence. 43 Depressed diabetes patients have been shown to be less likely to adhere to dietary recommendations and oral diabetes medications, and less often engage in regular physical activity compared to non-depressed diabetes patients.…”