School for Cardiovascular Disease (CARIM), Department of Internal Medicine, Maastricht University, Maastricht, The Netherlands.
Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom.
Diabet Med. 2022 Feb;39(2):e14671. doi: 10.1111/dme.14671. Epub 2021 Sep 5.
To investigate whether there is a bidirectional longitudinal association of depression with HbA .
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 HbA in adults. We assessed study quality with the Newcastle-Ottawa-Scale. Pooled effect estimates were reported as partial correlation coefficients (r ) or odds ratios (OR).
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 HbA 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 HbA (partial r = 0.07; [95% CI 0.03, 0.12]; I 38%). Higher baseline HbA values were also associated with 18% increased risk of (probable) depression (OR = 1.18; [95% CI 1.12,1.25]; I 0.0%).
Our findings support a bidirectional longitudinal association between depressive symptoms and HbA . 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 HbA levels could be targeted concurrently in the prevention and treatment of diabetes and depression.
PROSPERO ID CRD42019147551.
调查抑郁与糖化血红蛋白（HbA ）之间是否存在双向纵向关联。
我们在 PubMed、PsycINFO、CINAHL 和 EMBASE 中进行了系统文献检索，检索了 2000 年 1 月至 2020 年 9 月期间发表的观察性、纵向研究，评估了成年人中抑郁与 HbA 之间的关联。我们使用纽卡斯尔-渥太华量表评估研究质量。汇总效应估计值以偏相关系数（r ）或比值比（OR）报告。
我们检索到 1642 项研究；26 项研究被纳入系统综述，11 项研究被纳入荟萃分析。大多数研究（16/26）侧重于 2 型糖尿病。研究质量评定为良好（n=19）、中等（n=2）和较差（n=5）。在荟萃分析的研究中，有 6 项研究调查了自我报告的抑郁症状与 HbA 之间的纵向关联，5 项研究调查了相反的纵向关联，综合样本量为 n=48793，平均随访时间为 2 年。较高水平的基线抑郁症状与随后较高水平的 HbA 相关（偏相关 r=0.07；[95%CI 0.03，0.12]；I 2=38%）。较高的基线 HbA 值也与（可能）抑郁风险增加 18%相关（OR=1.18；[95%CI 1.12，1.25]；I 2=0.0%）。
我们的研究结果支持抑郁症状和 HbA 之间存在双向纵向关联。然而，观察到的效应大小较小，需要在大规模纵向研究中进一步证实这种关联。未来的研究应该调查糖尿病类型和抑郁、糖尿病困扰和糖尿病自我管理行为的作用。我们的研究结果可能具有临床意义，因为抑郁症状和 HbA 水平可能在糖尿病和抑郁的预防和治疗中同时成为治疗靶点。
PROSPERO ID CRD42019147551。
