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Do Lifestyle Interventions Fix Diabetes Depression?

Meta-analysis examines the effectiveness of interventions in improving and preventing diabetes depression.

Depression affects one in four individuals with type 2 diabetes mellitus (T2DM). The purpose of this study was to examine the influence of lifestyle interventions on depressive symptoms scores in individuals at-risk of or with T2DM.  Major bibliographic databases were searched for studies published in English from 1990-2015. Meta-analysis was conducted by random-effects model.

According to this meta-analysis, adults with type 2 diabetes saw reduced depression scores after completing a variety of lifestyle interventions. Adriana Cezaretto, PhD, of the department of epidemiology at the School of Public Health, University of Sao Paulo, Brazil, and colleagues wrote, “Among short-, intermediate- and longer-term intervention durations, it was evident, upon meta-analysis, that all durations were useful in reducing depression scores.” Furthermore, when the frequency of interventions was considered, substantial depression score improvement was found within the weekly frequency subset.

The findings further validate previous studies that demonstrate providing increased attention to individuals with chronic diseases could result in a greater sense of care and in turn improvements in depression outcomes.

In a systematic review, Cezaretto and colleagues analyzed information from 19 studies published between 1990 and 2015 examining adults at risk for or diagnosed with type 2 diabetes who completed validated depression assessments (n = 9,107). Studies were conducted in North American, European, Asian, Australian and Brazilian populations; antidepressant use was assessed in four studies. Study participants received interventions lasting 2 to 36 months (median, 6 months; n = 4,687) or served as controls (n = 4,420) and underwent a depression assessment at baseline and after intervention.

And what they discovered in the pooled analysis, researchers found that lifestyle interventions showed a small effect on improved depression scores (standardized mean difference [SMD] = –0.165; 95% CI, –0.265 to –0.064); results persisted when limited to individuals with type 2 diabetes (SMD = –0.202; 95% CI, –0.288 to –0.079).

Internet and telephone sessions did not affect depression scores. When stratified by type of intervention, researchers found that individual sessions (SMD = –0.241; 95% CI, –0.403 to –0.078) and group sessions (SMD = –0.209; 95% CI, –0.378 to –0.039) had a beneficial effect on depression scores. When stratified by frequency, researchers found that sessions provided four times per month showed the greatest effect on depression scores (SMD = –0.247; 95% CI, –0.441 to –0.053), followed by once a month (SMD = –0.201; 95% CI, –0.345 to –0.057).

“In general, interventions resulted in decreased depression scores regardless of the intensity and duration of intervention,” the researchers wrote. “In the meta-analysis, the interventions using individualized person-centered or group-session approaches were associated with significant depression score improvements.”

Having a conversation with a dietary coach was as effective as meeting with a counselor for problem-solving or “talk” therapy in preventing major depression among older black and white adults with mild symptoms of the mood disorder. Their findings were published online recently in Psychiatric Services.

Practice Pearls:

  • Face-to-face individual consultations most effectively improved depression scores.
  • Interventions were most effective when delivered four times a month.
  • It is essential that groups at risk of or with diabetes be screened for depression.

Cezaretto A, et al. Impact of lifestyle interventions on depressive symptoms in individuals at-risk of, or with, type 2 diabetes mellitus: A systematic review and meta-analysis of randomized controlled trials. Nutr Metab Cardiovasc. 2016;doi:10.1016/j.numecd.2016.0t4.009.