The limited efficacy of psychological interventions for depression in people with Type 1 or Type 2 diabetes: An Individual Participant Data Meta-Analysis (IPD-MA).

Background: People with either Type 1/Type 2 diabetes experiencing anxiety or depression experience worse clinical and social outcomes. Efficacy of available psychological and pharmacological treatments for anxiety and depression is unclear. Aggregate data meta-analyses (AD-MAs) have failed to consider the clinical relevance of any change these treatments elicit. Thus, we sought to complete an individual participant data meta-analysis (IPD-MA) to evaluate this.
Methods: Eligible RCTs of psychological treatments (PTs) and pharmacological treatments (PhTs) were systematically identified and assessed using the Cochrane Risk of Bias Tool-2. IPD was requested and Jacobson's methodology was used to determine the clinical relevance of symptom-change. Traditional effect sizes were calculated to permit comparison of trials providing and not providing IPD and to compare with AD-MAs.
Results: Sufficient data was obtained to conduct an IPD-MA for PTs (12/25) but not PhTs (1/5). Across PT trials, rates of 'recovery' for depression post-intervention were low. Whilst significantly more treated patients did recover (17% [95% CI 0.10, 0.25]) than controls (9% [95% CI 0.03, 0.17]), the difference was small (6% [95% CI 0.02, 0.10]).
Limitations: Only 50% of eligible trials provided IPD; we were also only able to examine outcomes immediately following the end of an intervention.
Conclusion: Current psychological interventions offer limited benefit in treating anxiety and depression in people with Type 1 or Type 2 diabetes (83% remain depressed). More efficacious interventions are urgently needed.
(Copyright © 2022 The Authors. Published by Elsevier B.V. All rights reserved.)