Effects of Light Therapy on Mood and Insulin Sensitivity in Patients With Type 2 Diabetes and Depression: Results From a Randomized Placebo-Controlled Trial

Brouwer, Annelies; Raalte, Daniël H. van; Nguyen, Hoang; Rutters, Femke; Ven, Peter M. van de; Elders, Petra; Moll, Annette C.; Someren, Eus J.W. Van; Snoek, Frank J.; Beekman, Aartjan; Bremmer, Marijke A.

doi:10.2337/dc18-1732

Cited by 26 publications

(30 citation statements)

References 40 publications

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“…Such strategies might be focussed on factors presented in the biopsychosocial model, including insulin resistance. For example, a randomized controlled trial demonstrated light therapy as being effective in diminishing depressive symptoms, especially in participants with type 2 diabetes with a major depressive disorder with higher levels of insulin resistance [26]. Although promising, further studies are needed to provide additional therapy options for depression in diabetes.…”

Section: Discussionmentioning

confidence: 99%

Biopsychosocial factors associated with a current depressive episode in diabetes: the ELSA‐Brasil study

et al. 2020

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Aims Depression is more prevalent in people with diabetes, and is associated with worse diabetes outcomes. Depression in diabetes is more treatment resistant, and as underlying mechanisms are unknown, development of more effective treatment strategies is complicated. A biopsychosocial model may improve our understanding of the pathophysiology, and therewith help improving treatment options. Methods Diabetes was diagnosed according to American Diabetes Association (ADA) criteria and a current depressive episode according to the International Classification of Diseases (ICD‐10), based on the Clinical Interview Schedule Revised (CIS‐R). From the Brazilian Longitudinal Study of Adult Health (ELSA‐Brasil), we included 455 participants without diabetes with a current depressive episode and 10 900 without either diabetes or a current depressive episode. Furthermore, 2183 participants had diabetes alone and 106 had both diabetes and a current depressive episode. Variable selection was based on their relationship with depression and/or diabetes. Multinomial multivariate logistic regression was used to determine how the models differed between participants with and without diabetes. Results A current depressive episode in diabetes was related to being older and female, having poorer education, financial problems, experiencing discrimination at work, home and school, higher waist circumference, albumin to creatinine ratio and insulin resistance, and the presence of hypertension and cardiovascular disease. In non‐diabetes, a current depressive disorder was related to being female, not being black, low income, psychological and social factors, non‐current alcohol use, lower HDL cholesterol, higher insulin resistance and the presence of cardiovascular disease. Conclusions A current depressive episode in the presence compared with the absence of diabetes was related more to biological than to psychosocial factors.

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Section: Discussionmentioning

confidence: 99%

Biopsychosocial factors associated with a current depressive episode in diabetes: the ELSA‐Brasil study

et al. 2020

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“…One interesting option is bright light therapy (BLT), which is known for its activating and synchronising effects and is used for treatment of CRSWDs and depression. A study in 83 people with type 2 diabetes and depression, showed that BLT reduced depressive symptoms (−3.9 [95% CI −9.0, 1.2] Inventory of Depressive Symptomatology points) and improved insulin sensitivity (0.15 mg/kg × min [95% CI −0.41, 0.70] measured using hyperinsulinaemic–euglycaemic clamp), although neither change was statistically significant [ 70 ].…”

Section: Treating Sleep Disorders In Type 2 Diabetesmentioning

confidence: 99%

Sleep disorders in people with type 2 diabetes and associated health outcomes: a review of the literature

et al. 2021

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Sleep disorders are linked to development of type 2 diabetes and increase the risk of developing diabetes complications. Treating sleep disorders might therefore play an important role in the prevention of diabetes progression. However, the detection and treatment of sleep disorders are not part of standardised care for people with type 2 diabetes. To highlight the importance of sleep disorders in people with type 2 diabetes, we provide a review of the literature on the prevalence of sleep disorders in type 2 diabetes and the association between sleep disorders and health outcomes, such as glycaemic control, microvascular and macrovascular complications, depression, mortality and quality of life. Additionally, we examine the extent to which treating sleep disorders in people with type 2 diabetes improves these health outcomes. We performed a literature search in PubMed from inception until January 2021, using search terms for sleep disorders, type 2 diabetes, prevalence, treatment and health outcomes. Both observational and experimental studies were included in the review. We found that insomnia (39% [95% CI 34, 44]), obstructive sleep apnoea (55–86%) and restless legs syndrome (8–45%) were more prevalent in people with type 2 diabetes, compared with the general population. No studies reported prevalence rates for circadian rhythm sleep–wake disorders, central disorders of hypersomnolence or parasomnias. Additionally, several cross-sectional and prospective studies showed that sleep disorders negatively affect health outcomes in at least one diabetes domain, especially glycaemic control. For example, insomnia is associated with increased HbA1c levels (2.51 mmol/mol [95% CI 1.1, 4.4]; 0.23% [95% CI 0.1, 0.4]). Finally, randomised controlled trials that investigate the effect of treating sleep disorders in people with type 2 diabetes are scarce, based on a small number of participants and sometimes inconclusive. Conventional therapies such as weight loss, sleep education and cognitive behavioural therapy seem to be effective in improving sleep and health outcomes in people with type 2 diabetes. We conclude that sleep disorders are highly prevalent in people with type 2 diabetes, negatively affecting health outcomes. Since treatment of the sleep disorder could prevent diabetes progression, efforts should be made to diagnose and treat sleep disorders in type 2 diabetes in order to ultimately improve health and therefore quality of life. Graphical abstract

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“…Eight trials with active comparator (CETs) were not entered in the meta‐analysis in accordance with the Cochrane Handbook instructions for dealing with heterogeneity (Higgins et al., 2019), as pooling was not possible because of heterogeneous control groups (Barragán‐Rodríguez et al., 2008; Gois et al., 2014; Gulseren et al., 2005; Kang et al., 2015; Karaiskos et al., 2013; Khazaie et al., 2011; Kumar et al., 2015; Petrak, Herpertz, et al., 2015). Three RCTs were not entered because they did not present the data required for pooling (Bastelaar et al., 2011; Brouwer et al., 2019; Ell et al., 2011). Thirty‐two RCTs with 3,543 patients with type 1 diabetes and type 2 diabetes were entered into the meta‐analysis (Bogner et al., 2012; Ebert et al., 2017; Echeverry et al., 2009; Ell et al., 2010; Groot et al., 2019; Guo et al., 2014; Hermanns et al., 2015; Huang et al., 2002, 2016; Johnson et al., 2014; Katon, Von Korff, et al., 2004; Li et al., 2003; Long et al., 2015; Lu Xs & Bx, 2005; Lustman, Freedland, et al., 2000; Lustman et al., 1997, 1998b; Naik et al., 2019; Newby et al., 2017; Paile‐Hyvärinen et al., 2003; Paile‐Hyvarinen et al., 2007; Penckofer et al., 2012; Pibernik‐Okanovic et al., 2009, 2015; Piette et al., 2011; Safren et al., 2014; Schneider et al., 2016; Simson et al., 2008; Tovote et al., 2014; Williams et al., 2004; Xue, 2004; Zheng et al., 2015) All studies were performed in patients with diabetes as the primary or index condition, who suffered from comorbid depressive disorder or subthreshold depression.…”

Section: Resultsmentioning

confidence: 99%

“…Among the 32 randomized controlled trials included in the meta‐analysis, most studies did not meet all criteria to reduce risk of bias, mostly due to unclear reporting about the method of randomization and blinding, instead the focus being on description of the intervention; unclear reporting about attrition rates and intention‐to‐treat (ITT) analysis. Furthermore, one study had low rates of compliance with the intervention under study and unclear reporting about the numbers of compliant participants (Brouwer et al., 2019); ten studies used small underpowered samples, despite otherwise being of seemingly adequate quality. Details of the risk‐of‐bias assessment for included trials are provided in the appendix (pp 4–7).…”

Section: Resultsmentioning

confidence: 99%

Treatment for comorbid depressive disorder or subthreshold depression in diabetes mellitus: Systematic review and meta‐analysis

et al. 2020

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Objective To provide an estimate of the effect of interventions on comorbid depressive disorder (MDD) or subthreshold depression in type 1 and type 2 diabetes. Methods Systematic review and meta‐analysis. We searched PubMed, PsycINFO, Embase, and the Cochrane Library for randomized controlled trials evaluating the outcome of depression treatments in diabetes and comorbid MDD or subthreshold symptoms published before August 2019 compared to care as usual (CAU), placebo, waiting list (WL), or active comparator treatment as in a comparative effectiveness trial (CET). Primary outcomes were depressive symptom severity and glycemic control. Cohen's d is reported. Results Forty‐three randomized controlled trials (RCTs) were selected, and 32 RCTs comprising 3,543 patients were included in the meta‐analysis. Our meta‐analysis showed that, compared to CAU, placebo or WL, all interventions showed a significant effect on combined outcome 0,485 (95% CI 0.360; 0.609). All interventions showed a significant effect on depression. Pharmacological treatment, group therapy, psychotherapy, and collaborative care had a significant effect on glycemic control. High baseline depression score was associated with a greater reduction in HbA1c and depressive outcome. High baseline HbA1c was associated with a greater reduction in HbA1c. Conclusion All treatments are effective for comorbid depression in type 1 diabetes and type 2 diabetes. Over the last decade, new interventions with large effect sizes have been introduced, such as group‐based therapy, online treatment, and exercise. Although all interventions were effective for depression, not all treatments were effective for glycemic control. Effective interventions in comorbid depressive disorder may not be as effective in comorbid subthreshold depression. Baseline depression and HbA1c scores modify the treatment effect. Based on the findings, we provide guidance for treatment depending on patient profile and desired outcome, and discuss possible avenues for further research.

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Effects of Light Therapy on Mood and Insulin Sensitivity in Patients With Type 2 Diabetes and Depression: Results From a Randomized Placebo-Controlled Trial

Cited by 26 publications

References 40 publications

Biopsychosocial factors associated with a current depressive episode in diabetes: the ELSA‐Brasil study

Biopsychosocial factors associated with a current depressive episode in diabetes: the ELSA‐Brasil study

Sleep disorders in people with type 2 diabetes and associated health outcomes: a review of the literature

Treatment for comorbid depressive disorder or subthreshold depression in diabetes mellitus: Systematic review and meta‐analysis

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