Abstract
AIMS/HYPOTHESIS: People with diabetes and depression show large heterogeneity in their response to depression treatment. This study aimed to identify biomarkers of subclinical inflammation that were associated with improvement of depressive symptoms in people with type 1 diabetes and type 2 diabetes. METHODS: The prospective analysis combined data from three studies (DIAMOS, ECCE HOMO and DDCT). A total of 332 people with type 1 diabetes and 189 people with type 2 diabetes completed both the baseline and 1 year follow-up examinations. Depressive symptoms were assessed using the Center for Epidemiological Studies depression scale (CES-D). Associations between baseline serum levels of 76 biomarkers of inflammation and 1 year changes in depressive symptoms were estimated using multiple linear regression. RESULTS: In people with type 2 diabetes, higher levels of 26 biomarkers were associated with greater reductions in depressive symptoms (β=0.128 to 0.255; p<0.05), whereas in people with type 1 diabetes, higher levels of 13 biomarkers were linked with lower reductions in depressive symptoms (β=-0.189 to -0.094; p<0.05). A significant effect modification was observed for 33 biomarkers (p(interaction)<0.05). The positive associations in type 2 diabetes were strongest for improvements in cognitive-affective and anhedonia symptoms, while the inverse associations in type 1 diabetes were strongest for improvements in somatic symptoms. CONCLUSIONS/INTERPRETATION: Higher baseline levels of multiple biomarkers of inflammation were associated with greater depression reduction in type 2 diabetes but lower depression reduction in type 1 diabetes. There were also diabetes type-specific differences in the associations with symptom clusters of depression. This suggests that different inflammation-related pathways may be relevant for the response to depression treatment in people with type 1 diabetes or type 2 diabetes.