U.S. Department of Defense


Date of this Version



Depress Anxiety. 2017;1–11.


U.S. Government Work


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,T2Dfamily 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 outcomeswere 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 inCBTandHE(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.