Effectiveness of eHealth-Based Psychological Interventions for Depression Treatment in Patients With Type 1 or Type 2 Diabetes Mellitus: A Systematic Review.

BACKGROUND: Comorbidity between diabetes mellitus and depression is highly prevalent. The risk of depression in a person with diabetes is approximately twice that of a person without this disease. Depression has a major impact on patient well-being and control of diabetes. However, despite the availability of effective and specific therapeutic interventions for the treatment of depression in people with diabetes, 50% of patients do not receive psychological treatment due to insufficient and difficult accessibility to psychological therapies in health systems. The use of information and communication technologies (ICTs) has therefore been proposed as a useful tool for the delivery of psychological interventions, but it continues to be a field in which scientific evidence is recent and controversial. This systematic review aims to update the available information on the efficacy of psychological interventions delivered through ICTs to improve depressive symptomatology in patients with diabetes. METHODS: A systematic review of the literature was performed following the PRISMA guidelines and using MEDLINE, Embase, PubMed, Web of Science, PsycINFO, Scopus, and Cochrane Library databases to search for randomized clinical trials of eHealth treatments for patients with diabetes and comorbid depression from 1995 through 2020. In addition, studies related to follow-up appointments were identified. Inclusion criteria were as follows: (a) randomized clinical trials (RCTs); (b) patients with type 1 and type 2 diabetes; (c) adult population over 18 years of age; (d) presence of depressive symptomatology assessed with standardized instruments; (e) treatments for depression based on established psychotherapeutic techniques and principles; (f) delivered through eHealth technologies. We did not limit severity of depressive symptomatology, delivery setting or comparison group (treatment as usual or other treatment). Two coauthors independently reviewed the publications identified for inclusion and extracted data from the included studies. A third reviewer was involved to discuss discrepancies found. The PEDro scale was used to assess the quality of the RCTs. No meta-analysis of the results was performed. The protocol used for this review is available in PROSPERO (Reg; CRD42020180405). RESULTS: The initial search identified 427 relevant scientific publications. After removing duplicates and ineligible citations, a total of 201 articles were analyzed in full text. Ten articles met the criteria of this review and were included, obtaining very good scientific quality after evaluation with the PEDro scale. The main results show that the eHealth psychological intervention for depression in patients with diabetes showed beneficial effects both at the end of treatment and in the short (3 months) and long term (6 and 12 months) for the improvement of depressive symptomatology. The methodology used (type of diabetes, eHealth technology used, recruitment context, implementation and follow-up) was very heterogeneous. However, all studies were based on cognitive-behavioral tools and used standardized assessment instruments to evaluate depressive symptomatology or diagnosis of MDD. Glycemic control was assessed by glycosylated hemoglobin, but no benefits were found in improving glycemic control. Only four studies included psychoeducational content on diabetes and depression, but none used tools to improve or enhance adherence to medical prescriptions or diabetes self-care. CONCLUSIONS: ICT-based psychological interventions for the treatment of depression in people with diabetes appear to be effective in reducing depressive symptomatology but do not appear to provide significant results with regard to glycemic control. Nonetheless, the scientific evidence reported to date is still very limited and the methodology very diverse. In addition, no studies have implemented these systems in routine clinical practice, and no studies are available on the economic analysis of these interventions. Future research should focus on studying and including new tools to ensure improvements in diabetes outcomes and not only on psychological well-being in order to advance knowledge about these treatments. Economic evaluations should also be undertaken to analyze whether these treatment programs implemented using eHealth technologies are cost-effective.

The Calculating Boluses on Multiple Daily Injections (CBMDI) study: A randomized controlled trial on the effect on metabolic control of adding a bolus calculator to multiple daily injections in people with type 1 diabetes.

BACKGROUND: Although the insulin bolus calculator is increasingly being used by people with type 1 diabetes (T1D) on multiple daily injection (MDI) therapy, few studies have investigated its effects on glycemic control. The aim of this study was to determine whether adding this device to therapeutic intensification could further improve metabolic control. METHODS: A 4-month randomized controlled clinical trial was performed comparing subjects undergoing therapeutic intensification and either using the bolus calculator (Cb group) or not (active control [Co] group). Metabolic control, fear of hypoglycemia, and treatment acceptance were evaluated. RESULTS: In all, 70 people completed the study (42 in the Cb group, 28 in the Co group). There was a significant decrease in HbA1c in both the Cb and Co groups (-7 mmol/mol [-0.7 %] vs -4 mmol/mol [-0.4 %], respectively). There were no significant differences in HbA1c at baseline or the end of the study, or in the decrease in HbA1c, glycemia, or changes in blood glucose levels at the end of the study between the two groups. There was a significant increase in the number of participants with good metabolic control (HbA1c <58 mmol/mol [7.5 %]) in the Cb group (from 16.7 % to 40.5 %), but not in the Co group. The incidence of hypoglycemic events was reduced slightly but significantly only in the Cb group. There was no change in the fear of hypoglycemia at the end of the study. The bolus calculator was well accepted. CONCLUSIONS: In T1D, adding a bolus calculator to intensive MDI resulted in a significant improvement in metabolic control and slightly decreased the number of hypoglycemic episodes. Metabolic control also improved in the Co group.

Precisión del diagnóstico de depresión en pacientes con diabetes mellitus tipo 1 / Accuracy of diagnosis of depression in patients with Type 1 diabetes mellitus

Este estudio valora la precisión que tiene el clínico (Médico Especialista en Endocrinología y Nutrición: MEEN) al realizar el diagnóstico de depresión en pacientes con diabetes mellitus tipo 1 (DM1). Participaron 11 MEEN y 153 pacientes con DM1. El diagnóstico de depresión se realizó mediante la entrevista estructurada SCID-1 y la valoración del clínico. De la muestra inicial se seleccionaron aleatoriamente 50 pacientes (imponiendo la condición de que estuviera compuesta por 25 pacientes con depresión y 25 sin depresión). Los resultados muestran que los clínicos realizaron un mayor porcentaje de diagnósticos negativos (paciente sin depresión) que positivos (paciente con depresión). Un porcentaje considerable de pacientes con depresión no fueron diagnosticados (25%). Parece, pues, necesario dotar a los clínicos de protocolos adecuados para evaluar la presencia de este trastorno en DM1, así como continuar la investigación sobre el proceso diagnóstico para la toma de decisiones clínicas (AU)

This study assesses the clinical accuracy of physicians (Specialists in Endocrinology and Nutrition: SEN) to make the diagnosis of depression in patients with Type 1 diabetes mellitus (DM1). This study involved 11 SEN physicians, and 153 patients with DM1. The diagnosis of depression was performed using the SCID-1 structured interview and clinical assessment. From the initial sample, 50 patients were randomly selected (imposing the condition that it was included 25 patients with depression and 25 without depression). The results show that clinicians performed a higher percentage of negative diagnoses (patients without depression) than positive ones (patients with depression). A significant percentage of patients with depression were not diagnosed (25%). It therefore seems necessary to provide adequate clinical protocols to evaluate the presence of this disorder in DM1, as well as continuing research into the diagnostic process for clinical decision making (AU)

[Accuracy of diagnosis of depression in patients with Type 1 diabetes mellitus]. / Precisión del diagnóstico de depresión en pacientes con diabetes mellitus tipo 1.

This study assesses the clinical accuracy of physicians (Specialists in Endocrinology and Nutrition: SEN) to make the diagnosis of depression in patients with Type 1 diabetes mellitus (DM1). This study involved 11 SEN physicians, and 153 patients with DM1. The diagnosis of depression was performed using the SCID-1 structured interview and clinical assessment. From the initial sample, 50 patients were randomly selected (imposing the condition that it was included 25 patients with depression and 25 without depression). The results show that clinicians performed a higher percentage of negative diagnoses (patients without depression) than positive ones (patients with depression). A significant percentage of patients with depression were not diagnosed (25%). It therefore seems necessary to provide adequate clinical protocols to evaluate the presence of this disorder in DM1, as well as continuing research into the diagnostic process for clinical decision making.