BACKGROUND Depressive symptoms frequently co-occur with diabetes and, when unaddressed, can function to 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 are no current meta-analyses examining their effects. PURPOSE In our study we summarize the effects of IC approaches to address depression and diabetes and examine moderating effects of IC approaches (e.g., behavioral intervention used; type of IC approach). DATA SOURCES A systematic search was conducted of PubMed, PsycInfo, CINAHL, and ProQuest. STUDY SELECTION Two reviewers triaged abstracts and full-text articles to identify relevant articles. Randomized controlled trials with enrollment of participants with diabetes and depressive symptoms and with provision of 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 From 517 abstracts, 75 full-text reports were reviewed and 31 studies with 8,843 participants were analyzed. Among 26 studies with reporting of 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. Among 23 studies with reporting of depressive symptoms, the pooled effect of IC approaches lowered depressive scores by 0.72 points (95% CI −1.15 to −0.28). LIMITATIONS The inclusion of a wide range of IC approaches increased study heterogeneity. A random effects model and sensitivity analyses mitigated this limitation. CONCLUSIONS IC approaches are associated with improved glycemia and depressive symptoms in comparison with treatment as usual.

中文翻译：

---

综合护理方法对解决同时发生的抑郁症和糖尿病的影响：系统评价和荟萃分析


背景 抑郁症状经常与糖尿病同时发生，如果不加以解决，会恶化糖尿病控制并增加糖尿病相关发病率的风险。综合护理 （IC） 方法旨在改善糖尿病和抑郁症患者的结局，但目前没有荟萃分析来检查其效果。目的 在我们的研究中，我们总结了 IC 方法对解决抑郁症和糖尿病的影响，并研究了 IC 方法的调节作用（例如，使用的行为干预;IC 方法的类型）。数据来源 对 PubMed 、 PsycInfo、 CINAHL 和 ProQuest 进行了系统检索。研究选择 两名评价员对摘要和全文文章进行分类，以确定相关文章。纳入了随机对照试验，招募了患有糖尿病和抑郁症状的参与者，并提供了关于抑郁评分和血红蛋白 A1c 的足够数据。资料提取 两名评价员提取了每项研究的人口统计信息、抑郁评分、糖尿病结局、干预细节和偏倚风险。数据综合 从 517 篇摘要中，回顾了 75 篇全文报告，并分析了 31 项研究，涉及 8,843 名参与者。在报告了 HbA1c 的 26 项研究中，IC 方法与 HbA1c 降低百分比的组间显著差异相关 （d = -0.36,95% CI -0.52 至 -0.21）。包括行为干预（行为激活与认知行为疗法）相结合的研究显示，HbA1c 的降低幅度更大。在报告抑郁症状的 23 项研究中，IC 方法的合并效应使抑郁评分降低了 0.72 分（95% CI [-1.15， -0.28]）。 局限性 纳入广泛的 IC 方法增加了研究异质性。随机效应模型和敏感性分析减轻了这一限制。结论 与常规治疗相比，IC 方法与改善血糖和抑郁症状相关。