Meta-Analysis
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Meta-Anal. Dec 18, 2024; 12(4): 97779
Published online Dec 18, 2024. doi: 10.13105/wjma.v12.i4.97779
Diabetes distress, the mediator of the poor glycemic control and depression: A meta-analysis
Hyder O Mirghani
Hyder O Mirghani, Department of Internal Medicine, University of Tabuk, Tabuk 51941, Tabuk Province, Saudi Arabia
Author contributions: Mirghani HO performed the conception and design of the study, and the literature search, performed the drafting and critical revision of the manuscript and provided the final approval of the version to be published.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hyder O Mirghani, MD, Professor, Department of Internal Medicine, University of Tabuk, Prince Fahd Bin Sultan, Tabuk 51941, Tabuk Province, Saudi Arabia. s.hyder63@hotmail.com
Received: June 8, 2024
Revised: November 1, 2024
Accepted: December 5, 2024
Published online: December 18, 2024
Processing time: 187 Days and 5.5 Hours
Abstract
BACKGROUND

Diabetes-related distress (DRD) is a common psychological disorder specifically associated with diabetes, its cross-talk with depression, and glycated hemoglobin (HbA1c) was discussed controversially. Interventions addressing DRD were shown to improve HbA1c. However, the primary concern is to investigate the association of DRD with glycemic control. No meta-analyses have compared the effects of depression and diabetes distress on HbA1c.

AIM

To assess the relationship between DRD, depression, and glycemic control.

METHODS

We systematically searched PubMed MEDLINE, Google Scholar, and Cochrane Library from inception up to May 2024. The keywords diabetes distress, depression, psychopathology, glycemic control, HbA1c, glycated hemoglobin, fasting, and postprandial blood glucose were used. A datasheet was used to extract the author’s name year and country of publication, diabetes distress, depression, and HbA1c among patients with DRD, depression, and control subjects.

RESULTS

Out of the 2046 studies retrieved, 55 full texts were screened and 22 studies were included in the final meta-analysis. Diabetes distress was associated with poor glycemic control, odd ratio = 0.42, 95% confidence interval (CI): 0.17-0.67, and P value < 0.001, and odd ratio = 0.52, 95%CI: 0.38-0.72, and P value < 0.001 respectively. No significant difference was observed between depression and DRD regarding the impact on HbA1c, odd ratio = 0.13, 95%CI: 0.15-0.41, P value = 0.37, I2 for heterogeneity = 76%. However, when heterogeneity was eliminated, diabetes distress influenced the HbA1c more compared to depression, odd ratio = 0.29, 95%CI: 0.17-0.41, and P value < 0.001.

CONCLUSION

DRD negatively influenced the HbA1c and glycemic control more than depression. Further studies using more specific measures (ecological momentary assessment) to assess DRD are recommended.

Keywords: Diabetes-related distress; Depression; Glycemic control; Glycated hemoglobin; Diabetes

Core Tip: Literature on the effects of diabetes distress is scarce, the available meta-analyses focused on interventions to tackle diabetes (to improve glycemic control) distress instead of investigating the direct influence of diabetes distress on the same. However, the association of depression with glycemic control was touched before. However, this is the first meta-analysis to compare the effects of diabetes distress and depression on glycated hemoglobin (HbA1c). We found an association between diabetes distress, depression, and HbA1c with a higher impact of distress arm compared to depression. Due to the overlap between the symptoms of diabetes distress and depression, diabetes distress could mediate the association between depression and HbA1c. Although the reverse could be true, diabetes distress is commoner than depression. The current findings challenged the scientific community and recommended screening for both diabetes distress and depression among patients with diabetes mellitus and poor glycemic control. In addition, we suggested future studies using continuous glucose monitoring and ecological momentary assessment to evaluate the association of diabetes distress, depression, and glycemic control.