Prevention of insulin resistance in adolescents at risk for type 2 diabetes with depressive symptoms: 1-year follow-up of a randomized trial

Lauren B. Shomaker*, Nichole R. Kelly, Rachel M. Radin, Omni L. Cassidy, Lisa M. Shank, Sheila M. Brady, Andrew P. Demidowich, Cara H. Olsen, Kong Y. Chen, Eric Stice, Marian Tanofsky-Kraff, Jack A. Yanovski

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

18 Scopus citations

Abstract

Background: Depression is associated with poor insulin sensitivity. We evaluated the long-term effects of a cognitive behavioral therapy (CBT) program for prevention of depression on insulin sensitivity in adolescents at risk for type 2 diabetes (T2D) with depressive symptoms. Methods: One-hundred nineteen adolescent females with overweight/obesity, T2D family history, and mild-to-moderate depressive symptoms were randomized to a 6-week CBT group (n = 61) or 6-week health education (HE) control group (n = 58). At baseline, posttreatment, and 1 year, depressive symptoms were assessed, and whole body insulin sensitivity (WBISI) was estimated from oral glucose tolerance tests. Dual energy X-ray absorptiometry assessed fat mass at baseline and 1 year. Primary outcomes were 1-year changes in depression and insulin sensitivity, adjusting for adiposity and other relevant covariates. Secondary outcomes were fasting and 2-hr insulin and glucose. We also evaluated the moderating effect of baseline depressive symptom severity. Results: Depressive symptoms decreased in both groups (P <.001). Insulin sensitivity was stable in CBT and HE (ΔWBISI:.1 vs.3) and did not differ between groups (P =.63). However, among girls with greater (moderate) baseline depressive symptoms (N = 78), those in CBT developed lower 2-hr insulin than those in HE (Δ-16 vs. 16 μIU/mL, P <.05). Additional metabolic benefits of CBT were seen for this subgroup in post hoc analyses of posttreatment to 1-year change. Conclusions: Adolescent females at risk for T2D decreased depressive symptoms and stabilized insulin sensitivity 1 year following brief CBT or HE. Further studies are required to determine if adolescents with moderate depression show metabolic benefits after CBT.

Original languageEnglish
Pages (from-to)866-876
Number of pages11
JournalDepression and Anxiety
Volume34
Issue number10
DOIs
StatePublished - Oct 2017
Externally publishedYes

Keywords

  • T2D mellitus
  • child/adolescent
  • clinical trials
  • depression
  • insulin resistance

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