Analyzing the effects of integrated care approaches to address co-occurring depression and diabetes: A systematic review and meta-analysis

Background: Depressive symptoms frequently co-occur with diabetes and, when unaddressed, can worsen diabetes control and increase the risk of diabetes-related morbidity. Integrated care (IC) approaches aim to improve outcomes among people with diabetes and depression, but there is no current meta-analysis examining their effects. Purpose: Our study summarizes the effects of IC approaches to address depression and diabetes while examining moderating effects (behavioral intervention; IC approach). Data Sources: A systematic search was conducted utilizing PubMed, PsycINFO, CINAHL, and ProQuest. Study Selection: Two reviewers triaged abstracts and full-text articles to identify relevant articles. Randomized controlled trials that enrolled participants with diabetes and depressive symptoms that provided sufficient data on depression scores and hemoglobin A1c were included. Data Extraction: Two reviewers extracted demographic information, depression scores, diabetes outcomes, intervention details, and the risk of bias for each study. Data Synthesis: Out of 517 abstracts, 75 full-text reports were reviewed, and 31 studies with 8,843 participants were analyzed. Of 26 studies reporting HbA1c, IC approaches were associated with a significant between-group difference regarding the percent decrease of HbA1c (d = -0.36, 95% CI: -0.52 to -0.21). Studies that included a combination of behavioral interventions (behavioral activation with cognitive behavioral therapy) showed greater reductions in HbA1c. Of 23 studies reporting depressive symptoms, the pooled effect of IC approaches lowered depressive scores by 0.72 points (95% CI: -1.15 to -0.28). Limitations and Conclusions: IC approaches are associated with improved glycemia and lower depressive symptoms compared with treatment as usual.