Cited by 138Diabetes Management and EducationMindfulness and Compassion InterventionsCancer survivorship and care

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Psychological interventions for diabetes-related distress in adults with type 2 diabetes mellitus

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Chew, Boon How, Vos, Rimke C, Metzendorf, Maria-Inti, Scholten, Rob JPM, Rutten, Guy EHM·2017·Cochrane Database of Systematic Reviews

DOI 10.1002/14651858.cd011469.pub2PMC PMC6483710

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Abstract

BACKGROUND: Many adults with type 2 diabetes mellitus (T2DM) experience a psychosocial burden and mental health problems associated with the disease. Diabetes-related distress (DRD) has distinct effects on self-care behaviours and disease control. Improving DRD in adults with T2DM could enhance psychological well-being, health-related quality of life, self-care abilities and disease control, also reducing depressive symptoms. OBJECTIVES: To assess the effects of psychological interventions for diabetes-related distress in adults with T2DM. SEARCH METHODS: We searched the Cochrane Library, MEDLINE, Embase, PsycINFO, CINAHL, BASE, WHO ICTRP Search Portal and ClinicalTrials.gov. The date of the last search was December 2014 for BASE and 21 September 2016 for all other databases. SELECTION CRITERIA: We included randomised controlled trials (RCTs) on the effects of psychological interventions for DRD in adults (18 years and older) with T2DM. We included trials if they compared different psychological interventions or compared a psychological intervention with usual care. Primary outcomes were DRD, health-related quality of life (HRQoL) and adverse events. Secondary outcomes were self-efficacy, glycosylated haemoglobin A1c (HbA1c), blood pressure, diabetes-related complications, all-cause mortality and socioeconomic effects. DATA COLLECTION AND ANALYSIS: Two review authors independently identified publications for inclusion and extracted data. We classified interventions according to their focus on emotion, cognition or emotion-cognition. We performed random-effects meta-analyses to compute overall estimates. MAIN RESULTS: We identified 30 RCTs with 9177 participants. Sixteen trials were parallel two-arm RCTs, and seven were three-arm parallel trials. There were also seven cluster-randomised trials: two had four arms, and the remaining five had two arms. The median duration of the intervention was six months (range 1 week to 24 months), and the median follow-up period was 12 months (range 0 to 12 months). The trials included a wide spectrum of interventions and were both individual- and group-based.A meta-analysis of all psychological interventions combined versus usual care showed no firm effect on DRD (standardised mean difference (SMD) -0.07; 95% CI -0.16 to 0.03; P = 0.17; 3315 participants; 12 trials; low-quality evidence), HRQoL (SMD 0.01; 95% CI -0.09 to 0.11; P = 0.87; 1932 participants; 5 trials; low-quality evidence), all-cause mortality (11 per 1000 versus 11 per 1000; risk ratio (RR) 1.01; 95% CI 0.17 to 6.03; P = 0.99; 1376 participants; 3 trials; low-quality evidence) or adverse events (17 per 1000 versus 41 per 1000; RR 2.40; 95% CI 0.78 to 7.39; P = 0.13; 438 participants; 3 trials; low-quality evidence). We saw small beneficial effects on self-efficacy and HbA1c at medium-term follow-up (6 to 12 months): on self-efficacy the SMD was 0.15 (95% CI 0.00 to 0.30; P = 0.05; 2675 participants; 6 trials; low-quality evidence) in favour of psychological interventions; on HbA1c there was a mean difference (MD) of -0.14% (95% CI -0.27 to 0.00; P = 0.05; 3165 participants; 11 trials; low-quality evidence) in favour of psychological interventions. Our included trials did not report diabetes-related complications or socioeconomic effects.Many trials were small and were at high risk of bias for incomplete outcome data as well as possible performance and detection biases in the subjective questionnaire-based outcomes assessment, and some appeared to be at risk of selective reporting. There are four trials awaiting further classification. These are parallel RCTs with cognition-focused and emotion-cognition focused interventions. There are another 18 ongoing trials, likely focusing on emotion-cognition or cognition, assessing interventions such as diabetes self-management support, telephone-based cognitive behavioural therapy, stress management and a web application for problem solving in diabetes management. Most of these trials have a community setting and are based in the USA. AUTHORS' CONCLUSIONS: Low-quality evidence showed that none of the psychological interventions would improve DRD more than usual care. Low-quality evidence is available for improved self-efficacy and HbA1c after psychological interventions. This means that we are uncertain about the effects of psychological interventions on these outcomes. However, psychological interventions probably have no substantial adverse events compared to usual care. More high-quality research with emotion-focused programmes, in non-US and non-European settings and in low- and middle-income countries, is needed.

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The Effect of Diabetes Management Shared Care Clinic on Glycated Hemoglobin A1c Compliance and Self-Management Abilities in Patients with Type 2 Diabetes Mellitus
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Real-World Data of a Group-Based Formula Low Energy Diet Programme in Achieving Type 2 Diabetes Remission and Weight Loss in an Ethnically Diverse Population in the UK: A Service Evaluation
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Akshatha, S., & Nayak, U. B. (2024) · Medicine in Drug Discovery · doi:10.1016/j.medidd.2024.100196 · Cited by 18
People with diabetes do not learn and recall their diabetes foot education: a cohort study
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The effectiveness of an emotion-focused educational programme in reducing diabetes distress in adults with type 2 diabetes mellitus at 12-month follow-up: a cluster randomized controlled trial
Chew, B., Vos, R. C., Fernandez, A., Ghazali, S. S., Shamsuddin, N. H., Ismail, M., & Rutten, G. E. H. M. (2019) · Therapeutic Advances in Endocrinology and Metabolism · doi:10.1177/2042018819853761 · Cited by 9
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Effectiveness of Nurse-Led Psychological Interventions on Diabetes Distress, Depression, and Glycemic Control in Individuals With Type 2 Diabetes Mellitus: A Systematic Review and Meta-Analysis
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The Relationship Between Quality of Life, Diabetes Distress, and Metabolic Control in Hungarian Type 1 Diabetic Patients: A Cross-Sectional Study
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Comparative Analysis of Different Classifiers Using Machine Learning Algorithm for Diabetes Mellitus
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Development of the Rheumatoid Arthritis Distress Scale (RADS): a new tool to identify disease-specific distress in patients with Rheumatoid Arthritis
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Do metacognitive beliefs predict rumination and psychological distress independently of illness representations in adults with diabetes mellitus? A prospective mediation study
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Effect of routinely assessing and addressing depression and diabetes distress using patient-reported outcome measures in improving outcomes among adults with type 2 diabetes: a systematic review protocol
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Loneliness, depression and sleep quality among the type 2 diabetic patients during COVID ‐19 local epidemic: A mediation analysis
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“More importantly, patients suffering from T2DM had a higher mental health risk (Chew et al., 2017).”
Continuous care needs in patients with cancer receiving chemotherapy during the recent omicron wave of COVID-19 in Shanghai: A qualitative study
Zhang, J., Wang, C., Huang, L., & Zhang, J. (2023) · Frontiers in Psychology · doi:10.3389/fpsyg.2022.1067238 · Cited by 6
Application of the path analysis model to evaluate the role of distress, mental health literacy and burnout in predicting self-care behaviors among patients with type 2 diabetes
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“The results of a systematic review and meta-analysis about psychological interventions for distress diabetes showed that different psychological interventions did not have a decisive effect on diabetes distress in the population with T2D compared to conventional care [57].”
Background
Profiles of knowledge, self-efficacy, psychological and physical health in type 2 diabetes and its association with outcomes
Wong, S., Lew, J. K., Soon, W. S. W., Griva, K., Smith, H. E., & Lim, S. C. (2024) · Patient Education and Counseling · doi:10.1016/j.pec.2024.108482 · Cited by 5
Women’s Wellness with Type 2 Diabetes Program (WWDP): Qualitative findings from the UK and Australian feasibility study
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Patient Perspectives on Self-Monitoring of Blood Glucose When not Using Insulin: a Cross-sectional Survey
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Psychological interventions for treating and preventing recurrence of foot ulcers in people with diabetes
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Factors associated with work ability in adults with diabetes
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The Impact of Moderate-to-High-Intensity Exercise Protocols on Glycated Hemoglobin Levels in Type 2 Diabetes Patients
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“Insulin deficiency also invariably leads to chronic hyperglycaemia, causing disturbances in carbohydrate, fat, and protein metabolism [6].”
Background
Treatment of type 2 diabetes and stress using neuro-emotional technique: case report
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Diabetes distress as mediators of loneliness and health promotion behaviour: a cross-sectional study
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“Provenance and peer review Not commissioned; externally peer reviewed.”
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The mediating role of psychological resilience in the effect of strength of religious faith on coping with stress in people with type 2 diabetes: A SEM analysis
Öztürk, Z., Turan, G. B., & Dönmez, O. (2024) · Nursing Open · doi:10.1002/nop2.70044 · Cited by 4
“(Chew et al., 2017).”
Background
Dulce Digital-Me: results of a randomized comparative trial of static versus adaptive digital interventions for Latine adults with diabetes
Philis‐Tsimikas, A., Fortmann, A. L., Clark, T. L., Bagsic, S. R. S., Farcas, E., Roesch, S. C., SCHULTZ, J. H., Gilmer, T., Godino, J., Savin, K. L., et al. (2024) · Annals of Behavioral Medicine · doi:10.1093/abm/kaae077 · Cited by 5
The impact of digital storytelling on psychosocial well-being in individuals with type 1 diabetes: a randomized clinical trial study in Iran
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“A Cochrane systematic review found no significant effect of psychological interventions on diabetes distress compared to usual care in T1D populations [16], highlighting the ongoing need for innovative, scalable, and effective approaches.”
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Meditation for the primary and secondary prevention of cardiovascular disease
Rees, K., Court, R. A., Takeda, A., & Ernst, E. (2019) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd013358 · Cited by 4
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“Similarly, Guy E. H. M. Rutten from the University Medical Centre Utrecht has focused on depression symptoms, well-being, and HRQoL [32] and examined the e ﬃ cacy of self-management education and psychological support in alleviating patient distress [33 – 35].”
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Schipper, S. B. J., Karagiannis, T., Zaccardi, F., Remmelzwaal, S., Blom, M. T., Dagan, N., Schoonmade, L. J., Langendam, M. W., Mb, J., Jensen, W., et al. (2026) · Diabetologia · doi:10.1007/s00125-026-06789-0 · Cited by 3
“For instance, a large Cochrane review specifically focused on psychological interventions for diabetes distress in adults with type 2 diabetes found a small but significant effect on diabetes distress in favour of psychological interventions compared with usual care [11].”
Factors Associated with Diabetes-Related Distress in Patients with Type 2 Diabetes Mellitus
Duka, K., Onea, C. R., & Cernea, S. (2021) · Journal of Interdisciplinary Medicine · doi:10.2478/jim-2021-0027 · Cited by 3
Analysis of Psychosocial Factors Affecting Dietary Behavior among People with Type 2 Diabetes Mellitus in Indonesia
Rondhianto, R., Ridla, A. Z., & Budi, F. A. K. S. (2023) · Jurnal Keperawatan Soedirman · doi:10.20884/1.jks.2023.18.3.6488 · Cited by 7
“Support from family can increase motivation and prevent stress (Chew et al., 2017), self-management behavior (Kurnia et al., 2017; Yamin & Sari, 2018), especially in dietary behavior compliance (Demilew et al., 2018; Ghimire, 2017).”
Background
Effect of an entry-to-care intervention on diabetes distress in individuals with newly diagnosed type 2 diabetes: a study protocol for a cluster-randomized trial
Hansen, S. H., Jensen, T. M., Petersen, G. S., Pouwer, F., Sønderlund, A. L., & Søndergaard, J. (2024) · Trials · doi:10.1186/s13063-024-07949-6 · Cited by 3
Towards integrated cardiovascular and mental health management in primary health care in Indonesia: a policy outlook
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“26,30,56,57 Having a chronic disease in itself may lead to MH conditions if not addressed properly.”
Is insomnia severity a moderator of the associations between obstructive sleep apnea severity with mood and diabetes-related distress?
Jeon, B., Chasens, E. R., Luyster, F. S., Callan, J. A., DiNardo, M. M., & Sereika, S. M. (2023) · Sleep And Breathing · doi:10.1007/s11325-023-02819-y · Cited by 4
Psychosocial Interventions by Nurses for Patients with HIV/ AIDS: A Systematic Review
Davoudi, M., Heydari, A., & Manzari, Z. S. (2023) · Journal of Caring Sciences · doi:10.34172/jcs.2023.30726 · Cited by 3
Efficient and Effective Diabetes Care in the Era of Digitalization and Hypercompetitive Research Culture: A Focused Review in the Western Pacific Region with Malaysia as a Case Study
Chew, B., Lai, P. S. M., Sivaratnam, D., Basri, N. I., Appannah, G., Yusof, B. N. M., Thambiah, S. C., Hanipah, Z. N., Wong, P. F., & Chang, L.-C. (2025) · Health Systems & Reform · doi:10.1080/23288604.2024.2417788 · Cited by 4
Self-citation
Increased Levels of Serum Glycosylated Hemoglobin are Associated with Depressive Symptoms in a Population with Cancer (≥49 Years): An Antidepressant-Stratified Analysis
Huang, Y., Xu, Y., & Liu, A. (2021) · Clinical Interventions in Aging · doi:10.2147/cia.s294704 · Cited by 3
“Some patients believe that the use of insulin indicates a serious condition, so the psychological pressure is greater, and the pessimistic mood is more serious.(26,27) Second, if the blood glucose control is not good, the patients may have complications in 5–10 years, which is a threat to the patients, which will inev…”
Background
Retracted
Medicina Conductual: Avances y Perspectivas
(2021) · Qartuppi eBooks · doi:10.29410/qtp.21.11 · Cited by 4
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“…well-being interventions, primarily yoga based, can improve measures of glycemic control, including fasting and post-prandial glucose, HbA1c, and measures of adiposity and obesity risk (Chew et al., 2017; Jayawardena et al., 2018; Pascoe et al., 2017; Ramamoorthi et al., 2019; Thind et al., 2017).”
Chronic medical diseases and depressive symptoms in Europe: A study using representative data from 275,009 individuals in the third wave of the European Health Interview Survey (EHIS-3)
Chae, W. R., Kuhnert, R., Buchmann, M., Sarganas, G., Grams, D., Michalski, N., Otte, C., & Hapke, U. (2025) · Journal of Affective Disorders · doi:10.1016/j.jad.2025.120210 · Cited by 3

Authors: Chew, B. H., Vos, R. C., Metzendorf, M.-I., Scholten, R. J., & Rutten, G. E.
Affiliations: Universiti Putra Malaysia (MY)
University Medical Center Utrecht (NL)
Heinrich Heine University Düsseldorf (DE)
ORCID: Chew, Boon How
Vos, Rimke C
Metzendorf, Maria-Inti
Rutten, Guy EHM
Venue: Cochrane Database of Systematic Reviews
Publisher: Wiley
Published: 2017-09-27
Volume: 2017
Issue: 10
Pages: CD011469-CD011469
ISSN: 1361-6137 (ISSN-L)
1465-1858
DOI: 10.1002/14651858.cd011469.pub2
PMC: PMC6483710
OpenAlex: W2161920207
Cited by: 138
References: 238
Citations by year: 2026: 8 · 2025: 14 · 2024: 21 · 2023: 17 · 2022: 23 · 2021: 22 · 2020: 16 · 2019: 6 · 2018: 8 · 2017: 2
FWCI: 6.92
Type: journal article
Language: en
Open access: green
www.ncbi.nlm.nih.gov
Locations: Cochrane Database of Systematic Reviews (publishedVersion)
PubMed Central (publishedVersion)
PubMed (publishedVersion)
Universiti Putra Malaysia Institutional Repository (Universiti Putra Malaysia) (acceptedVersion)
Utrecht University Repository (Utrecht University) (submittedVersion, other-oa)
Utrecht University Repository (Utrecht University) (submittedVersion)
Funders: National Institute for Health and Care Research (PB-PG-0610-22311)
Topics: Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
Health Sciences › Medicine › Oncology › Cancer survivorship and care
Keywords: diabetes distress, type 2 diabetes, psychological intervention, health-related quality of life, self-efficacy, glycemic control, HbA1c, depression, diabetes self-management education, cognitive behavioral therapy, group intervention, emotion-focused interventions, cognitive intervention, socioeconomic burden, diabetes complications, mortality, adverse events, self-care behavior, blood pressure control
MeSH terms: Adult, Depression, Diabetes Mellitus, Type 2, Glycated Hemoglobin, Humans, Psychotherapy, Quality of Life, Self Care, Stress, Psychological, Randomized Controlled Trials as Topic

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Psychological interventions for diabetes-related distress in adults with type 2 diabetes mellitus

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