Diaz Bustamante Liliana, Ghattas Kyrillos N, Ilyas Shahbakht, Al-Refai Reham, Maharjan Reeju, Khan Safeera
Family Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA.
Internal Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA.
Cureus. 2020 Sep 20;12(9):e10551. doi: 10.7759/cureus.10551.
Diabetes is a chronic disease with a high prevalence in the United States. If not treated adequately, it can have serious complications. Furthermore, when depression affects concomitantly, adherence to treatment can be decreased. Therefore, a cascade of complications may develop, affecting the quality of life and increasing the risk of death. Depression is underdiagnosed in patients with diabetes, and even if diagnosed, the treatment for both diabetes and depression is not well established in primary care. This study aims to evaluate if treatment for depression with collaborative care can improve glycemic levels and depression treatment response in diabetic patients with depression. As well, we will investigate if treatment with antidepressants will aid in improving glycemic levels. For this systematic review, we followed Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines and used PubMed, PubMed Central, and MEDLINE as database. Keywords: "diabetes improvement with depression treatment'. For collaborative care intervention, we selected three systematic reviews and meta-analysis. These three studies gave us a total of 1637 patients evaluated for the glycemic outcome and 1793 patients for depression outcomes. For the intervention with antidepressants, we included two articles. One systematic review and meta-analysis that evaluated the effect of selective serotonin reuptake inhibitors (SSRIs) on glycemic levels and the second article involved was a systematic review that assessed the effect of antidepressants on glycemia. A total of 4119 diabetic patients taking antidepressants were evaluated for glucose levels of the outcome. For the collaborative care outcome: two of the three studies showed non-significant improvement of glycemic levels with intervention. However, one study that had a bigger sample size exhibited significant improvement of glycemia with collaborative care. It is necessary to elaborate on new studies to confirm this finding. For the glycemic outcome with antidepressants: SSRIs improve glycemic levels. This class of antidepressants is the most studied, and it would be interesting to perform trials comparing different classes of antidepressants with a bigger sample size and run for a more extended period. According to our review, collaborative care improves glycemia and depression treatment response. At the same time, it improves the adherence to treatment of both oral hypoglycemic drugs and antidepressants. SSRIs demonstrated to be more effective in glycemic control. The most studied and effective SSRIs are fluoxetine, escitalopram, and citalopram.
糖尿病是一种在美国患病率很高的慢性疾病。如果治疗不充分，它可能会引发严重的并发症。此外，当抑郁症同时出现时，治疗依从性可能会降低。因此，可能会引发一系列并发症，影响生活质量并增加死亡风险。糖尿病患者中抑郁症的诊断不足，即使被诊断出来，在初级医疗保健中，糖尿病和抑郁症的治疗方法也尚未完全确立。本研究旨在评估采用协作护理治疗抑郁症是否能改善糖尿病合并抑郁症患者的血糖水平和抑郁症治疗反应。此外，我们将研究使用抗抑郁药治疗是否有助于改善血糖水平。对于这项系统评价，我们遵循系统评价与Meta分析的首选报告项目（PRISMA）指南，并使用PubMed、PubMed Central和MEDLINE作为数据库。关键词：“通过抑郁症治疗改善糖尿病”。对于协作护理干预，我们选择了三项系统评价和Meta分析。这三项研究总共纳入了1637名接受血糖结果评估的患者和1793名接受抑郁症结果评估的患者。对于使用抗抑郁药的干预，我们纳入了两篇文章。一篇系统评价和Meta分析评估了选择性5-羟色胺再摄取抑制剂（SSRI）对血糖水平的影响，另一篇涉及的文章是一项评估抗抑郁药对血糖影响的系统评价。共有4119名服用抗抑郁药的糖尿病患者接受了血糖水平结果评估。对于协作护理结果：三项研究中的两项显示干预后血糖水平改善不显著。然而，一项样本量更大的研究显示协作护理使血糖有显著改善。有必要开展新的研究来证实这一发现。对于使用抗抑郁药的血糖结果：SSRI可改善血糖水平。这一类抗抑郁药是研究最多的，进行样本量更大、持续时间更长的比较不同类抗抑郁药的试验将会很有意思。根据我们的评价，协作护理可改善血糖水平和抑郁症治疗反应。同时，它还能提高口服降糖药和抗抑郁药的治疗依从性。SSRI在血糖控制方面显示出更有效。研究最多且最有效的SSRI是氟西汀、艾司西酞普兰和西酞普兰。
