Research Program for Diagnosis and Treatment of Mental Disorder, Trimbos Instituut/Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands.
Gen Hosp Psychiatry. 2010 Jul-Aug;32(4):380-95. doi: 10.1016/j.genhosppsych.2010.03.011. Epub 2010 May 15.
Comorbid depression in diabetes is highly prevalent, negatively impacting well-being and diabetes control. How depression in diabetes is best treated is unknown.
This systematic review and meta-analysis aims to establish the effectiveness of existing anti-depressant therapies in diabetes.
PubMed, Psycinfo, Embase and Cochrane library. Study eligibility criteria, participants, interventions: randomized controlled trials (RCTs) evaluating the outcome of treatment by psychotherapy, pharmacotherapy or collaborative care of depression in persons with Type 1 and Type 2 diabetes mellitus.
risk of bias assessment; data extraction. Synthesis methods: data synthesis, random model meta analysis and publication bias analysis.
Meta analysis of 14 RCTs with a total of 1724 patients show that treatment is effective in terms of reduction of depressive symptoms: -0.512; 95% CI -0.633 to -0.390. The combined effect of all interventions on clinical impact is moderate, -0.370; 95% CI -0.470 to -0.271; it is large for psychotherapeutic interventions that are often combined with diabetes self management: -0.581; 95% CI -0.770 to -0.391, n=310 and moderate for pharmacological treatment: -0.467; 95% CI -0.665 to -0.270, n=281. Delivery of collaborative care, which provided a stepped care intervention with a choice of starting with psychotherapy or pharmacotherapy, to a primary care population, yielded an effect size of -0.292; 95% CI -0.429 to -0.155, n=1133; indicating the effect size that can be attained on a population scale. Pharmacotherapy and collaborative care aimed at and succeeded in the reduction of depressive symptoms but, apart from sertraline, had no effect on glycemic control.
amongst others, the number of RCTs is small.
The treatment of depression in people with diabetes is a necessary step, but improvement of the general medical condition including glycemic control is likely to require simultaneous attention to both conditions. Further research is needed.
糖尿病合并抑郁的发病率很高，严重影响患者的幸福感和糖尿病控制。目前尚不清楚治疗糖尿病合并抑郁的最佳方法。
本系统评价和荟萃分析旨在确定现有抗抑郁治疗方法在糖尿病中的疗效。
PubMed、Psycinfo、Embase 和 Cochrane 图书馆。研究入选标准、参与者、干预措施：评估 1 型和 2 型糖尿病患者接受心理治疗、药物治疗或协作护理治疗抑郁结局的随机对照试验（RCT）。
偏倚风险评估；数据提取。综合方法：数据综合、随机模型荟萃分析和发表偏倚分析。
对 14 项 RCT（共 1724 例患者）进行荟萃分析显示，治疗在降低抑郁症状方面有效：-0.512；95%CI-0.633 至-0.390。所有干预措施对临床影响的综合效应为中度，-0.370；95%CI-0.470 至-0.271；心理治疗干预通常与糖尿病自我管理相结合，其综合效应较大，-0.581；95%CI-0.770 至-0.391，n=310；药物治疗的综合效应为中度，-0.467；95%CI-0.665 至-0.270，n=281。针对初级保健人群提供分级护理干预（可选择从心理治疗或药物治疗开始）的协作护理，其效果大小为-0.292；95%CI-0.429 至-0.155，n=1133；表明在人群层面上可以达到的效果大小。药物治疗和协作护理旨在降低抑郁症状，并取得了成功，但除舍曲林外，对血糖控制没有影响。
除其他外，RCT 的数量较少。
治疗糖尿病患者的抑郁是必要的，但改善包括血糖控制在内的整体医疗状况可能需要同时关注这两种情况。需要进一步研究。
