A Randomized Controlled Trial to Prevent Depression and Ameliorate Insulin Resistance in Adolescent Girls at Risk for Type 2 Diabetes
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Prospective data suggest depressive symptoms worsen insulin resistance and accelerate type 2 diabetes (T2D) onset.
We sought to determine whether reducing depressive symptoms in overweight/obese adolescents at risk for T2D would increase insulin sensitivity and mitigate T2D risk.
We conducted a parallel-group, randomized controlled trial comparing a 6-week cognitive–behavioral (CB) depression prevention group with a 6-week health education (HE) control group in 119 overweight/obese adolescent girls with mild-to-moderate depressive symptoms (Center for Epidemiological Studies—Depression Scale [CES-D] ≥16) and T2D family history. Primary outcomes were baseline to post-intervention changes in CES-D and whole body insulin sensitivity index (WBISI), derived from 2-h oral glucose tolerance tests. Outcome changes were compared between groups using ANCOVA, adjusting for respective baseline outcome, puberty, race, facilitator, T2D family history degree, baseline age, adiposity, and adiposity change. Multiple imputation was used for missing data.
Depressive symptoms decreased (p < 0.001) in CB and HE from baseline to posttreatment, but did not differ between groups (ΔCESD = −12 vs. −11, 95 % CI difference = −4 to +1, p = 0.31). Insulin sensitivity was stable (p > 0.29) in CB and HE (ΔWBISI = 0.1 vs. 0.2, 95 % CI difference = −0.6 to +0.4, p = 0.63). Among all participants, reductions in depressive symptoms were associated with improvements in insulin sensitivity (p = 0.02).
Girls at risk for T2D displayed reduced depressive symptoms following 6 weeks of CB or HE. Decreases in depressive symptoms related to improvements in insulin sensitivity. Longer-term follow-up is needed to determine whether either program causes sustained decreases in depressive symptoms and improvements in insulin sensitivity.
Trial Registration Number
The trial was registered with clinicaltrials.gov (NCT01425905).
KeywordsAdolescence Depression Insulin resistance Type 2 diabetes Randomized controlled trial
This study was supported by K99HD069516 and R00HD069516 (L.B.S.) from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH) Intramural Research Program grant 1ZIAHD000641 (J.A.Y.) from NICHD with supplemental funding from the NIH Bench to Bedside Program (L.B.S., M.T., J.A.Y.), Office of Behavioral and Social Sciences Research (J.A.Y.), and the NIH Office of Disease Prevention (J.A.Y.). C.K.P. was supported by a training award from the NIH Office of the Director. S.A.A. was supported by the NIH Medical Research Scholars Program, a public–private partnership supported jointly by the NIH and generous contributions to the Foundation for the NIH from Pfizer Inc., The Doris Duke Charitable Foundation, The Newport Foundation, The American Association for Dental Research, The Howard Hughes Medical Institute, and the Colgate Palmolive Company, as well as other private donors. The authors acknowledge the assistance of Heather Shaw, Ph.D., Oregon Research Institute, for her help in rating intervention sessions for fidelity and leader competence.
Compliance with Ethical Standards
Conflict of Interest and Adherence to Ethical Standards
The material presented in this manuscript is original research. It has not been previously published, nor is it under review elsewhere. The research was carried out in compliance with the ethical standards of the American Psychological Association and the American Medical Association. None of the authors has a conflict of interest to disclose.
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