Psychological interventions to improve glycemic control in adults with type 2 diabetes: a systematic review and meta-analysis

Abstract

The quality of evidence that psychological interventions are effective in improving glycemic control in adults with type 2 diabetes (T2D) is weak.

We conducted a systematic review and meta-analysis of psychological interventions in T2D to assess whether their effectiveness in improving glycemic levels has improved over the past 30 years. We applied the protocol of a systematic review and aggregate meta-analysis conducted to January 2003. We added network meta-analysis (NMA) to compare intervention and control group type against usual care. MEDLINE, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, EMBASE, Cochrane Controlled Trials Database, Web of Science, and Dissertation Abstracts International were searched from January 2003 to July 2018. Only randomized controlled trials (RCT) of psychological interventions for adults with T2D reported in any language were included. The primary outcome was change in glycemic control (glycated hemoglobin (HbA1c) in mmol/mol). Data were extracted from study reports and authors were contacted for missing data.

94 RCTs were eligible for inclusion in the systematic review since the last review. In 70 RCTs (n=14 796 participants) the pooled mean difference in HbA1c in those randomized to psychological intervention compared with control group was −0.19 (95% CI −0.25 to −0.12), equivalent to a reduction in HbA1c of 3.7 mmol/mol, with moderate heterogeneity across studies (I2=64.7%, p<0.001). NMA suggested the probability of intervention effectiveness is highest for self-help materials, cognitive–behavioral therapy, and counseling, compared with usual care. Limitations of this study include that there is a possibility that some studies may have been missed if diabetes did not appear in the title or abstract.

The effectiveness of psychological interventions for adults with T2D have minimal clinical benefit in improving glycemic control.

PROSPERO registration number CRD42016033619.

Metadata

Authors/Creators:	Winkley, K. Upsher, R. Stahl, D. Pollard, D. https://orcid.org/0000-0001-5630-0115 Brennan, A. https://orcid.org/0000-0002-1025-312X Heller, S.R. https://orcid.org/0000-0002-2425-9565 Ismail, K.
Copyright, Publisher and Additional Information:	© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY. Published by BMJ. This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.
Keywords:	meta-analysis; psychology; randomized controlled trial; type 2 diabetes
Dates:	Accepted: 14 February 2020 Published (online): 8 April 2020 Published: 8 April 2020
Institution:	The University of Sheffield
Academic Units:	The University of Sheffield > Faculty of Medicine, Dentistry and Health (Sheffield) > School of Health and Related Research (Sheffield) > ScHARR - Sheffield Centre for Health and Related Research
Depositing User:	Symplectic Sheffield
Date Deposited:	27 Apr 2020 14:35
Last Modified:	25 Jun 2023 22:14
Status:	Published
Publisher:	BMJ
Refereed:	Yes
Identification Number:	https://doi.org/10.1136/bmjdrc-2019-001150
Related URLs:	PubMed URL

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Psychological interventions to improve glycemic control in adults with type 2 diabetes: a systematic review and meta-analysis

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