Research Institute Diabetes Academy Mergentheim (FIDAM), Diabetes Center Mergentheim (DZM), Johann-Hammer- Straße 24, 97980 Bad Mergentheim, Germany.
German Center for Diabetes Research (DZD), Ingolstädter Landstraße 1, 85764, Oberschleißheim, Germany.
Curr Diabetes Rev. 2024;20(3):e020623217607. doi: 10.2174/1573399820666230602124223.
Hyperglycemia constitutes a likely pathway linking diabetes and depressive symptoms; lowering glycemic levels may help reduce diabetes-comorbid depressive symptoms. Since randomized controlled trials can help understand temporal associations, we systematically reviewed the evidence regarding the potential association of hemoglobin HbA1c lowering interventions with depressive symptoms.
PubMed, PsycINFO, CINAHL, and EMBASE databases were searched for randomized controlled trials evaluating HbA1c-lowering interventions and including assessment of depressive symptoms published between 01/2000-09/2020. Study quality was evaluated using the Cochrane Risk of Bias tool. PROSPERO registration: CRD42020215541.
We retrieved 1,642 studies of which twelve met our inclusion criteria. Nine studies had high and three unclear risks of bias. Baseline depressive symptom scores suggest elevated depressive symptoms in five studies. Baseline HbA1c was <8.0% (<64 mmol/mol) in two, 8.0-9.0% (64-75 mmol/mol) in eight, and ≥10.0% (≥86 mmol/mol) in two studies. Five studies found greater HbA1c reduction in the treatment group; three of these found greater depressive symptom reduction in the treatment group. Of four studies analyzing whether the change in HbA1c was associated with the change in depressive symptoms, none found a significant association. The main limitation of these studies was relatively low levels of depressive symptoms at baseline, limiting the ability to show a lowering in depressive symptoms after HbA1c reduction.
We found insufficient available data to estimate the association between HbA1c reduction and depressive symptom change following glucose-lowering treatment. Our findings point to an important gap in the diabetes treatment literature. Future clinical trials testing interventions to improve glycemic outcomes might consider measuring depressive symptoms as an outcome to enable analyses of this association.
高血糖可能是糖尿病和抑郁症状之间的联系途径；降低血糖水平可能有助于减少糖尿病共患的抑郁症状。由于随机对照试验可以帮助理解时间关联，我们系统地回顾了关于降低血红蛋白 HbA1c 干预与抑郁症状之间潜在关联的证据。
在 PubMed、PsycINFO、CINAHL 和 EMBASE 数据库中检索了 2000 年 1 月至 2020 年 9 月期间发表的评估 HbA1c 降低干预措施并包括抑郁症状评估的随机对照试验。使用 Cochrane 偏倚风险工具评估研究质量。PROSPERO 注册：CRD42020215541。
我们检索到 1642 项研究，其中 12 项符合我们的纳入标准。9 项研究的偏倚风险高，3 项研究的偏倚风险不清楚。基线抑郁症状评分表明 5 项研究中有较高的抑郁症状。2 项研究的基线 HbA1c<8.0%（<64 mmol/mol），8 项研究的基线 HbA1c 为 8.0-9.0%（64-75 mmol/mol），2 项研究的基线 HbA1c≥10.0%（≥86 mmol/mol）。5 项研究发现治疗组的 HbA1c 降低幅度更大；其中 3 项研究发现治疗组的抑郁症状减轻幅度更大。在分析 HbA1c 变化是否与抑郁症状变化相关的 4 项研究中，没有一项发现显著关联。这些研究的主要局限性是基线时抑郁症状相对较低，限制了 HbA1c 降低后抑郁症状降低的能力。
我们发现可用数据不足以估计降低 HbA1c 与葡萄糖降低治疗后抑郁症状变化之间的关联。我们的研究结果指出了糖尿病治疗文献中的一个重要空白。未来测试改善血糖结果的干预措施的临床试验可能会考虑将抑郁症状作为一种结果进行测量，以分析这种关联。
