Abstract
Background
Depression is associated with poor insulin sensitivity. We evaluated 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 six-week CBT group (n=61) or six-week health education (HE) control group (n=58). At baseline, post-treatment, and one 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 one year. Primary outcomes were one-year changes in depression and insulin sensitivity, adjusting for adiposity and other relevant covariates. Secondary outcomes were fasting and two-hour insulin and glucose. We also evaluated the moderating effects of baseline depressive symptom severity.
Results
Depressive symptoms decreased in both groups (P<0.001). Insulin sensitivity was stable in CBT and HE (ΔWBISI 0.1 vs. 0.3) and did not differ between groups (P=0.63). However, among girls with greater (moderate) baseline depressive symptoms (N=78), those in CBT developed lower 2-hour insulin than those in HE (Δ-16 vs. 16μIU/mL, P<.05). Additional metabolic benefits of CBT were seen for this subgroup in post-hoc analyses of post-treatment to one-year change.
Conclusions
Adolescent females at risk for T2D decreased depressive symptoms and stabilized insulin sensitivity one year following brief CBT or HE. Further studies are required to determine if adolescents with moderate depression show metabolic benefits after CBT.