The bidirectional longitudinal association between depressive symptoms and HbA_1c: A systematic review and meta‐analysis

Abstract

Aim To investigate whether there is a bidirectional longitudinal association of depression with HbA1c. Methods We conducted a systematic literature search in PubMed, PsycINFO, CINAHL and EMBASE for observational, longitudinal studies published from January 2000 to September 2020, assessing the association between depression and HbA1c in adults. We assessed study quality with the Newcastle‐Ottawa‐Scale. Pooled effect estimates were reported as partial correlation coefficients (rp) or odds ratios (OR). Results We retrieved 1642 studies; 26 studies were included in the systematic review and eleven in the meta‐analysis. Most studies (16/26) focused on type 2 diabetes. Study quality was rated as good (n = 19), fair (n = 2) and poor (n = 5). Of the meta‐analysed studies, six investigated the longitudinal association between self‐reported depressive symptoms and HbA1c and five the reverse longitudinal association, with a combined sample size of n = 48,793 and a mean follow‐up of 2 years. Higher levels of baseline depressive symptoms were associated with subsequent higher levels of HbA1c (partial r = 0.07; [95% CI 0.03, 0.12]; I238%). Higher baseline HbA1c values were also associated with 18% increased risk of (probable) depression (OR = 1.18; [95% CI 1.12,1.25]; I20.0%). Conclusions Our findings support a bidirectional longitudinal association between depressive symptoms and HbA1c. However, the observed effect sizes were small and future research in large‐scale longitudinal studies is needed to confirm this association. Future studies should investigate the role of type of diabetes and depression, diabetes distress and diabetes self‐management behaviours. Our results may have clinical implications, as depressive symptoms and HbA1c levels could be targeted concurrently in the prevention and treatment of diabetes and depression. Registration PROSPERO ID CRD42019147551.

Pathomechanisms of Vascular Depression in Older Adults

“…Another possibility explaining the association between hyperglycemia and LLD is its involvement via generalized MVD [ 79 ] and inflammation [ 113 ], which both may lead to CSVD [ 114 ], and subsequent depression [ 79 , 115 ]. Several meta-analyses have examined the role of hyperglycemia in the etiology of LLD and found evidence that continuous hyperglycemia levels may be involved in the development of depression [ 116 ], which is in line with a large cross-sectional study demonstrating the association between diabetes and higher prevalence of depression [ 117 ]. In conclusion, there is evidence for many metabolic factors, including hyperglycemia, obesity, and type 2 diabetes as important metabolic risk factors in LLD.…”

Relations of Well-Being, Coping Styles, Perception of Self-Influence on the Diabetes Course and Sociodemographic Characteristics with HbA1c and BMI Among People with Advanced Type 2 Diabetes Mellitus

“…The results of a recent meta-analysis of longitudinal studies indicate that the baseline level of depression is much more associated with the risk of increased levels of glycated hemoglobin (HbA1c) than vice versa. 3 The results for other psychological and social factors are not as well documented. Two large international studies Diabetes, Attitudes, Wishes and Needs (DAWN) 4 and the Second DAWN study/DAWN2 5 did not take into consideration a level of HbA1c, that reflects the average blood glucose concentration at approximately 3 months before the test, with the majority (about 60%) of HbA1c being formed in the last month before the test.…”

Flourishing mental health and lifestyle behaviours in adults with Type 1 and Type 2 Diabetes Mellitus: results from the Diabetes MILES – The Netherlands Study

“…There is a large body of research that has demonstrated that mental ill-health among people with diabetes increases changes of an unhealthy lifestyle [11], cardiovascular complications [12], and all-cause mortality [13]. Associations between mental ill-health and glycated haemoglobin (HbA 1c ) seem bi-directional: depressive symptoms have been associated with developing suboptimal HbA1c, and suboptimal HbA1c has been associated with an increased risk of developing depression [14].…”