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Psychological, behavioural and biological changes following treatments of subsyndromal depression in people with type 2 diabetes

Background and aims: Evidence-based data on clinical benefits of treating subsyndromal depression is scarce. This study was aimed at determining the effects of three behavioural treatments -psychoeducation, physical exercise and diabetes re-education - in type 2 diabetic patients reporting mild depressive symptoms. Materials and methods: A sample of 209 type 2 diabetic patients with subsyndromal depression (aged 57±6 yrs, 54% female, with diabetes duration of 11±8 yrs, 32% insulin treated, with HbA1c of 7.3%±1.2 and BMI of 30±5 kg/m2) were randomly assigned to either psychoeducation and physical exercise, or the control arm. The interventions were aimed at alleviating depressive symptoms by psychoeducation relying on cognitive-behavioural skills, and physical exercise based on physical activation in six weekly group sessions. The control arm consisted of one patient-centred diabetes re-educational session. The assessments of depressive symptoms, diabetes distress, diabetes self-care and health-related quality of life were made by using validated questionnaires. Metabolic status was assessed by HbA1c and lipid panel (triglycerides, total, HDL and LDL cholesterol). Leukocytes (total, neutrophils, lymphocytes and mononuclear cells), myeloperoxidase index (MPXI), CRP, and plasma uric acid were used as endogenous inflammatory and antioxidant markers. The same psychological and laboratory measurements were repeated after the completion of the interventions, and after a six- month follow-up period. Repeated measures ANOVA was used to determine within- and between-group differences at follow- ups. Results: Psychological outcomes including depressive symptoms, diabetes distress, subjective health, emotional roles and mental health improved after the interventions and remained so after six months, regardless of the group assignment (all time effects' p<0.001). Diabetes-related diet improved after the treatments (p<0.001) but deteriorated at six month follow-up (p=0.01). Physical exercise, blood glucose self-monitoring and foot care demonstrated stable improvement (all time effects' p<0.001). Glycaemic control was slightly but significantly improved in all groups (p=0.002). A significant drop in total cholesterol was observed after the treatment (p=0.01), but this was not maintained after six months in any of the groups. CRP was not changed, whereas leukocyte, neutrophil and lymphocyte counts significantly decreased (all p<0.001) throughout the follow-up period. MPXI recovered to baseline levels after a significant post-treatment drop (p<0.001). Plasma uric acid remained unchanged in men, but increased significantly in women of all three groups at follow-up (p<0.001). Conclusion: The employed behavioural interventions were shown to have comparable positive effects on six-month outcomes including depressive symptoms, diabetes-related distress, health-related quality of life, diabetes self-care, glycaemic control, and markers of chronic inflammation. Treating subthreshold depressive symptoms in type 2 diabetic patients by even a minimal behavioural intervention has favourable clinical implications.

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