Reduction of depressive symptoms predicts improved glycaemic control: Secondary results from the DIAMOS study

Abstract

Aims: Evidence from randomised trials analysing effects of depression treatment on glycaemic control in group comparisons is inconsistent. The aim of this study was to test if the reduction of depressive symptoms would explain improved glycaemic control irrespective of treatment groups.

Methods: The DIAMOS study tested effects of cognitive-behavioural therapy (CBT) versus usual care on depressive symptoms in a 12-month prospective trial; HbA_1c was a secondary outcome. Since the results suggested superiority of CBT for improving depressive symptoms, but not HbA_1c, we conducted this secondary analysis to test if reduction of depressive symptoms could explain improved glycaemic control when assessed irrespective of treatment group affiliation. Reduction of depressive symptoms was assessed using baseline-to-follow-up changes in the Center for Epidemiologic Studies Depression Scale (CES-D). We used multiple regression analyses, adjusting for baseline HbA_1c and depression, group affiliation and covariates, to assess associations between reduction of depressive symptoms and follow-up HbA_1c.

Results: 181 participants provided eligible data. Depressive symptoms decreased between baseline and follow-up by averagely -5.1±11.8 CES-D points. Greater reduction of depressive symptoms predicted greater improvement of HbA_1c at follow-up, while adjusting for baseline HbA_1c and covariates (Beta=-0.24, P=0.004). Additionally, patients with greater reduction of depressive symptoms were more likely to reach in-target HbA_1c (<7.5%) at follow-up (adjusted OR=1.04, 95% CI 1.01-1.08, P=0.023).

Conclusions: The findings suggest that reduction of depressive symptoms can explain improved glycaemic control. Behavioural treatments might aim to improve both affective and glycaemic outcomes.

Keywords: Affective disorder; Depression; HbA(1c); Hyperglycaemia; Metabolic control; Mood.