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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“In the general literature, there is mixed evidence on interventions to reduce diabetes-related distress, and the vast majority of interventions tested involve face-to-face contactdan unsuitable format in the current context (39).”

See all 138

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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