Repositioning of diabetes treatments for depressive symptoms: A systematic review and meta-analysis of clinical trials
Abstract
Depression is a common comorbidity in diabetes but conventional antidepressant treatments do not consistently improve outcomes. We tested whether established diabetes treatments can also improve depressive symptoms and examined biological correlates of response. We performed a multi-database systematic search of all clinical trials, which measured the effect of licensed diabetes treatments on depressive symptoms using a validated questionnaire. Results of randomised controlled trials (RCT's) were pooled for meta-analysis. Data were also collected on insulin resistance (HOMA-IR), C-reactive protein (CRP) and fasting blood glucose (FBG) as correlates of response. Nineteen studies (n = 3369 patients) were included in the qualitative synthesis, 9 testing thiazolidenediones, 5 metformin, 2 thiazolidenediones against metformin, 2 incretin-based therapies and 1 insulin. Most studies were of good quality. In random-effects meta-analysis of RCT's, pioglitazone improved depressive symptoms compared to controls (pooled effect size = -0.68 (95% C.I. -1.12 to -0.24), p = .003, Nstudies = 8, I2 = 83.2%). Conversely, metformin was comparable to controls overall (pooled effect size = +0.32 (95% C.I. -0.23 to 0.88), p = .25, Nstudies = 6, I2 = 94.2%), although inferior to active controls (pooled effect size = +1.32 (95% C.I. 0.31-2.34), p < 0.001, Nstudies = 3, I2 = 90.1%). In random-effects meta-regression, female sex (β = -0.023, (95% C.I.-0.041 to -0.0041), p = .016, Nstudies = 8)…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 3,369 participants or records.
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