Psychosocial Aspects


Magdalena Beran, Rutendo Muzambi, Anouk Geraets, Juan Rafael Albertorio-Diaz, Marcel C. Adriaanse, Marjolein M. Iversen, Andrzej Kokoszka, Giesje Nefs, Arie Nouwen, Frans Pouwer, Jörg W. Huber, Andreas Schmitt, Miranda T. Schram, for the European Depression in Diabetes (EDID) Research Consortium

The bidirectional longitudinal association between depressive symptoms and HbA1c: A systematic review and meta-analysis. Diabet Med . 2022 Feb;39(2):e14671.

Depression and diabetes are among the most prevalent morbidities worldwide, with prevalences expected to rise. For type 2 diabetes and depression a bi-directional association has been often described. This association may be driven by suboptimal blood glucose levels, although studies investigating associations between depression and HbA1c levels have resulted in inconsistent findings. Additionally, these data are mostly based on cross-sectional studies and the most recent meta-analysis was performed more than 20 year ago. More recently, a meta-analysis showed the reverse association, between HbA1c and depression, for people with previously diagnosed diabetes (but not for newly diagnosed diabetes or impaired glucose metabolism). However, this study lacked sufficient power.


In this systematic review and meta-analysis, in which Giesje Nefs of Diabeter was involved, studies reporting longitudinal data were collected to investigate associations between depression and HbA1c levels and vice versa. It was hypothesized that increased levels of HbA1c result in a higher risk for depression and vice versa.


Key finding:

  • A bidirectional association was found between depression and HbA1c, despite a relatively small number of studies that could be included

In addition to the strengths of this study (comprehensive search including four databases, addressing both directions of the association between depression and HbA1c, inclusion of papers in multiple languages and of longitudinal studies), a few important limitations should be mentioned:

  • Due to the limited number of studies that could be included:
    • Publication bias could not be formally assessed
    • Meta-regression or sensitivity analyses could not be performed
  • Majority of included studies were in people with type 2 diabetes
  • Use of self-report questionnaires instead of clinical diagnosis


Concluding, the authors state

"Future studies should investigate the role of type of diabetes and depression, diabetes distress and diabetes self-management behaviours in the bidirectional association between HbA1c and depression over time. ........ In relation to clinical practice, the findings suggest that depression and HbA1c levels should be targeted concurrently by prevention and treatment efforts " -

Please click here for the pdf file.

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