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Cited by 47Diabetes Management and EducationAnxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesMindfulness and Compassion Interventions

The efficacy of cognitive behavioral therapy-based intervention on patients with diabetes: a meta-analysis

Open access
Li, Yanni, Storch, Eric A., Ferguson, Samantha, Li, Li, Buys, Nicholas, Sun, Jing·2022·Diabetes Research and Clinical Practice
DOI 10.1016/j.diabres.2022.109965
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Abstract

AIMS This meta-analysis aims to update former meta-analyses from randomized controlled trials (RCT) focused on the efficacy of CBT for diabetes. METHODS Five databases were searched for RCTs. Primary outcomes were glycated hemoglobin (HbA1c), fasting blood glucose (FBS), systolic blood pressure (SBP), diastolic blood pressure (DBP), and body mass index (BMI). Secondary outcomes were depression, anxiety and distress symptoms, quality of life, sleep quality. RESULTS 32 RCTs were included. Results revealed that CBT could reduce HbA1c: -0.14% (95% CI: -0.25 to -0.02%, P = 0.020); FBS: -15.48 mg/dl (95% CI: -30.16 to -0.81 mg/dl, P = 0.040); DBP: -2.88 mmHg (95% CI: -4.08 to -1.69 mmHg, P < 0.001); depression symptoms: -0.90 (95% CI: -1.22 to -0.57, P < 0.001); anxiety symptoms: -0.28 (95% CI: -0.50 to -0.07, P = 0.009); improve sleep quality: -0.92 (95% CI: -1.77 to -0.07, P = 0.030). Subgroup analysis indicated that CBT has siginificantly reduced HbA1c when delivered as a group-based and face-to-face method, and psycho-education, behavioral, cognitive, goal-setting, homework assignment strategies were applied as central strategies. CONCLUSION CBT was an effective treatment for diabetes patients, significantly reduced their HbA1c, FBS, DBP, depression and anxiety symptoms, and improved sleep quality.

AI snapshot

Written from the paper’s full text.

TL;DR

This meta-analysis of 32 RCTs found CBT-based interventions significantly reduced HbA1c, fasting blood glucose, diastolic blood pressure, depression and anxiety symptoms, and improved sleep quality in adults with diabetes. Effects on HbA1c, DBP, and depression persisted at follow-up, but heterogeneity was often high and publication bias was significant for HbA1c and FBS.

Key findings

  • Across 32 RCTs (7006 participants), CBT reduced HbA1c by -0.14% (95% CI -0.25 to -0.02, P = 0.020), FBS by -15.48 mg/dl (95% CI -30.16 to -0.81, P = 0.040), DBP by -2.88 mmHg (95% CI -4.08 to -1.69, P < 0.001), depression symptoms by SMD -0.90 (95% CI -1.22 to -0.57, P < 0.001), anxiety symptoms by SMD -0.28 (95% CI -0.50 to -0.07, P = 0.009), and improved sleep quality by SMD -0.92 (95% CI -1.77 to -0.07, P = 0.030). No significant effects were found for SBP, BMI, distress symptoms, or quality of life.
  • At follow-up, CBT effects remained for HbA1c (-0.36%, 95% CI -0.52 to -0.19, P < 0.001; 12 studies), DBP (-2.03 mmHg, 95% CI -3.54 to -0.52, P = 0.009; 3 studies), and depression symptoms (-7.99, 95% CI -15.42 to -0.56, P = 0.040; 10 studies).
  • Subgroup analysis found HbA1c was significantly reduced in T2DM, group-based, face-to-face, session duration ≥50 min, dropout <20%, DM-specific manual, and when psycho-education, behavioral, cognitive, goal-setting, and homework assignment strategies were central. Depression was significantly reduced with <10 sessions, no DM-specific manual, and psycho-education, cognitive, problem-solving, and homework assignment strategies.

Methods

  • Systematic review and meta-analysis following PRISMA, registered at PROSPERO (CRD42020213587). Five databases (PubMed, Embase, Cochrane Central Register of Controlled Trials, Scopus, Proquest) were searched from inception to April 2021, restricted to English. Included RCTs of adults aged ≥18 with T1DM, T2DM, or GDM receiving CBT or CBT-based intervention versus non-CBT, usual care, or waiting list.
  • 32 RCTs were included, with 7006 participants (3603 intervention, 3403 control). Random-effects meta-analysis was conducted in Review Manager 5.3 using WMD/SMD with 95% CI; heterogeneity was assessed with chi-square and I², publication bias with Egger test and funnel plots, and study quality with the PEDro tool.

Limitations

  • Stated by the paper: significant heterogeneity was present, possibly because there is no standard CBT procedure for diabetes (differences in number of sessions, session duration, treatment duration, and therapists’ backgrounds); only 13 studies reported use of an intervention manual and few reported supervision, making CBT quality unpredictable; only English-language articles were included, so eligible non-English studies may have been missed.
  • Evident from the text: many pooled analyses had high heterogeneity (e.g., depression I² = 100%, sleep quality I² = 96%, FBS I² = 87%); Egger test indicated significant publication bias for HbA1c (P = 0.030) and FBS (P = 0.012); sleep quality was based on only 3 studies; and most included studies were moderate quality (30/32), with only 2 rated high quality.

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Registry

Crossref · 10.1016/j.diabres.2022.109965

Cites

83 of 83 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 43 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    CBT-based interventions did not significantly reduce systolic blood pressure in patients with diabetes (-1.88 mmHg, 95% CI -4.54 to 0.79 mmHg, P = 0.170).

    “We did not find a significant reduction in systolic blood pressure (-1.88 mmHg, 95% CI: -4.54 to 0.79 mmHg, P = 0.170), and the heterogeneity among these studies was not significant (I 2 = 33%, P = 0.190) (Table 2).”
    Quote in the paperSubstantial claim
  • Findingown data

    CBT-based interventions improved sleep quality in patients with diabetes with a standardized mean difference of -0.92 (95% CI -1.77 to -0.07, P = 0.030).

    “improve sleep quality: -0.92 (95% CI: -1.77 to -0.07, P = 0.030).”
    • Also stated in: § 3.3.3 Effects on quality of life and sleep quality · plain
      “As shown in Table 2, a significant difference between the CBT and control groups was observed for the change in sleep quality scores (-2.14, 95% CI: -4.15 to -0.14, P = 0.040), with a large effect size of SMD -0.92 (95% CI: -1.77 to -0.07, P = 0.030).”
    Quote in the paperSubstantial claim
  • Findingown data

    CBT-based interventions reduced diastolic blood pressure (DBP) in patients with diabetes by -2.88 mmHg (95% CI -4.08 to -1.69 mmHg, P < 0.001).

    “DBP: -2.88 mmHg (95% CI: -4.08 to -1.69 mmHg, P < 0.001);”
    • Also stated in: § 3.3 Treatment effects of CBT-based intervention 3.3.1 Effects on physiological factors · plain
      “The CBT-based intervention was found to be more effective in reducing diastolic blood pressure in comparison with control conditions (-2.88 mmHg, 95% CI: -4.08 to -1.69 mmHg, P < 0.001) with a small effect size of SMD -0.31 (95% CI: -0.47 to -0.15).”
    Quote in the paperSubstantial claim
  • Findingown data

    CBT-based interventions reduced depression symptoms in patients with diabetes with a standardized mean difference of -0.90 (95% CI -1.22 to -0.57, P < 0.001).

    “depression symptoms: -0.90 (95% CI: -1.22 to -0.57, P < 0.001);”
    • Also stated in: § 3.3.2 Effects on psychological factors · plain
      “The metaanalysis results showed that CBT-based intervention was associated with a reduction the pool mean difference of depression symptoms of -5.67 (95% CI: -9.52 to -1.82, P = 0.004), with a large effect size of SMD -0.90 (95% CI: -1.22 to -0.57, P < 0.001).”
    Quote in the paperSubstantial claim
  • Findingown data

    CBT-based interventions reduced fasting blood glucose (FBS) in patients with diabetes by -15.48 mg/dl (95% CI -30.16 to -0.81 mg/dl, P = 0.040).

    “FBS: -15.48 mg/dl (95% CI: -30.16 to -0.81 mg/dl, P = 0.040);”
    • Also stated in: § 3.3 Treatment effects of CBT-based intervention 3.3.1 Effects on physiological factors · plain
      “There was evidence of a larger decrease in fasting blood glucose levels in the CBTbased intervention group when compared to the control group (-15.48 mg/dl, 95% CI: -30.16 to -0.81 mg/dl, P = 0.040) with a small effect size of SMD -0.43 (95% CI: -0.83 to -0.03).”
    Quote in the paperSubstantial claim
  • May combine two claims. 22
  • The quote only partly states this claim. 2
  • Classified as probably not a substantial claim. 19

  • May combine two claims.

    Findingown data

    7006 participants were included in the 32 RCTs, with 3603 in the intervention group and 3403 in the control group.

    “There were 7006 participants included in the 32 RCTs, with 3603 in the intervention group and 3403 in the control group.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    CBT-based interventions were able to significantly reduce the PSQI scores and improve sleep quality in patients with diabetes.

    “the results showed that CBT-based interventions were able to significantly reduce the PSQI scores and improve sleep quality in patients with diabetes.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingreasoning

    There are differences in the number of sessions, duration of each session, duration of the treatment, and therapists' professional backgrounds among the studies.

    “There are differences in the number of sessions, duration of each session, duration of the treatment, and therapists' professional backgrounds.”
    Quote in the paperSubstantial claim

  • The quote only partly states this claim.

    Findingown data

    CBT is effective in reducing depression level when the number of sessions is less than 10.

    “Additionally, subgroup analysis found that CBT is effective in reducing depression level when the number of sessions is less than 10.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductown data

    The methodological quality of included studies was high in 2 (6.25%) and moderate in 30 (93.75%) according to the PEDro tool.

    “The PEDro tool was chosen to assess the quality of included studies, with two being high quality, accounting for 6.25%, and the remaining 30 being medium quality, accounting for 93.75%.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Previous meta-analyses on CBT for DM patients had limitations: some restricted diagnostic types to T1DM or T2DM, one limited participants to non-hospitalized patients, and some did not focus on CBT.

    “However, certain reviews restricted the diagnostic types to T1DM 21 or T2DM 23 , and one review limited the participants to non-hospitalized patients 26 .Furthermore, some reviews did not focus on CBT 21,27 .”
    Quote in the paperSubstantial claim0 of 3 sources checked
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  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    Publication bias was assessed using the Egger test, funnel plot, and cut-and-fill method.

    “As for publication bias, we used the Egger test via Stata Statistical Software 17.A significant publication bias was defined with a p-value of less than 0.05.A funnel plot was also presented to analyze if there was a publication bias when the number of meta-analysis studies was more than ten.Cut-and-fill method was used to assess the sensitivity if there was a significant publication bias.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    T2DM is non-insulin-dependent diabetes, and it is more related to modifiable factors, including obesity, unhealthy eating habits, and sedentary lifestyle.

    “T2DM is non-insulin-dependent diabetes, and it is more related to modifiable factors, including obesity, unhealthy eating habits, and sedentary lifestyle 75 .”
    Quote in the paperSubstantial claim0 of 1 sources checked
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    Study design and conductnone given

    The systematic review followed PRISMA guidelines.

    “This systematic review followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductown data

    Egger test showed minimal publication bias for SBP, DBP, BMI, depression, anxiety, distress, quality of life, and sleep quality, but significant publication bias for HbA1c and FBS.

    “Egger test (Table 6) results showed that there was a minimal publication bias in SBP (P = 0.598), DBP (P = 0.172), BMI (P = 0.422), depression symptom (P = 0.349), anxiety symptom (P = 0.362), distress symptom (P = 0.169), quality of life (P = 0.732), sleep quality (P = 0.339).However, the publication bias for HbA 1c (P = 0.030) and FBS (P = 0.012) was significant.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    The PEDro tool was used to evaluate methodological quality by two reviewers independently.

    “The PEDro tool 29 was used to evaluate the methodological quality for the included articles by two reviewers independently.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Disagreements were resolved by a third researcher.

    “If there was a disagreement, a third researcher was invited to participate in the discussion and to reach a consensus.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    Two researchers searched five databases independently.

    “Two researchers searched PubMed, Embase, Cochrane Central Register of Controlled Trials, Scopus, Proquest separately with a time limitation from inception to April 2021, using the keywords of”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationcitation

    CBT may improve medication compliance, increase exercise time and frequency, promote eating habits, and improve blood glucose monitoring behaviors, all of which are conducive to blood glucose and blood pressure management.

    “The medication compliance of patients with diabetes may be improved 18 , exercise time and frequency might be increased 36 , eating habits promoted 52 , and blood glucose monitoring behaviors improved 18 , all of which are conducive to blood glucose and blood pressure management.”
    Quote in the paperSubstantial claim0 of 3 sources checked
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    Interpretationcitation

    Through CBT-based intervention, patients' nonadaptive cognitions of the disease could be improved, and dysfunctional behaviors alleviated.

    “Through the CBT-based intervention, including strategies such as developing therapeutic alliances, automatic thinking recognition and correction, cognitive reconstruction, and behavior activation, homework assignment, patients' nonadaptive cognitions of the disease could be improved, and the dysfunctional behaviors alleviated 24 .”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [24] source

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  • May combine two claims. The quote only partly states this claim.

    Interpretationown data

    The group-based and face-to-face intervention modes are statistically effective for reducing HbA1c.

    “Thirdly, the group-based and face-toface intervention modes are statistically effective.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    The review protocol was registered at PROSPERO (CRD42020213587).

    “The review protocol was registered at the PROSPERO International Prospective Register of Systematic Reviews (Registration ID: CRD42020213587 PROSPERO 2020 website: https://www.crd.york.ac.uk/prospero/#recordDetails).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    CBT-based intervention could effectively improve glycemic control, including HbA1c and fasting blood glucose, as well as diastolic blood pressure in patients with diabetes.

    “Consistent with previous studies 24,45,56,64 , our meta-analysis showed that CBT-based intervention could effectively improve glycemic control, including HbA 1c and fasting blood glucose, as well as diastolic blood pressure in patients with diabetes.”
    Quote in the paperSubstantial claim0 of 4 sources checked
    • cites [24] source

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    • cites [45] source

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    • cites [56]

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    • cites [64]

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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    T1DM refers to absolute insulin deficiency caused by autoimmune destruction of β cells of the pancreas.

    “T1DM refers to the absolute insulin deficiency, which is caused by the autoimmune destruction of β cells of the pancreas 73 .”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [73]

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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Most T1DM patients rely on lifelong insulin treatment.

    “Most T1DM patients rely on lifelong insulin treatment 74 .”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [74]

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  • May combine two claims.

    Interpretationown data

    CBT is statistically effective in reducing HbA1c in T2DM patients, but the effect is not significant in T1DM patients.

    “Firstly, CBT is statistically effective in reducing HbA 1c in T2DM patients, but the effect is not significant in T1DM patients.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Depression is a significant factor associated with unhealthy eating behavior, physical inactivity, and poor self-management in DM patients.

    “For example, depression has been studied as a significant factor associated with unhealthy eating behavior, physical inactivity [13][14][15] , and poor self-management in DM patients 1,16 .”
    Quote in the paperSubstantial claim0 of 3 sources checked
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    Interpretationcitation

    Through CBT, patients' negative emotions were improved, thereby their endocrine and metabolic abnormality may be alleviated.

    “Through CBT, patients' negative emotions were improved, thereby their endocrine and metabolic abnormality may be alleviated 72 .”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [72]

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  • May combine two claims.

    Interpretationown data

    CBT-based interventions are effective for patients with diabetes, being superior to active or usual care controls, significantly reducing HbA1c, FBS, DBP, depression and anxiety symptoms, and improving sleep quality.

    “CBT was an effective treatment for diabetes patients, significantly reduced their HbA 1c , FBS, DBP, depression and anxiety symptoms, and improved sleep quality.”
    • Also stated in: § [Insert Table 6] 4 Discussion · plain
      “We found that CBT-based interventions were superior to the active or usual care controls.They significantly reduced HbA 1c , fasting blood glucose, diastolic blood pressure, depression symptoms, anxiety symptoms, and improved sleep quality.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S4 (based).

    Study design and conductnone given

    The systematic review and meta-analysis used a reasonable number of RCTs of moderate to high quality.

    “We undertook a systematic review and meta-analysis on the efficacy of CBT-based interventions for DM patients using a reasonable number of RCTs of moderate to high quality.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Interpretationreasoning

    There is no standard procedure for CBT for diabetes, which may explain the significant heterogeneity among the studies.

    “The possible reason is that there is no standard procedure for CBT for diabetes.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    CBT has been widely used in emotion management of patients with chronic diseases, such as coronary heart disease, hypertension, chronic pain, and cancer, with satisfying effects.

    “It has been widely used in the emotion management of patients with chronic diseases, such as coronary heart disease 81 , hypertension 82 , chronic pain 83 , and cancer 84 , with satisfying effects.”
    Quote in the paperNot a substantial claim0 of 3 sources checked
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  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

    Premisecitation

    The treatment manual is an essential base of psychotherapy, including CBT.

    “The treatment manual is an essential base of psychotherapy, including CBT 76,77 .”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [76] source

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    Premisecitation

    The finding that CBT is efficient when emphasizing psychoeducation, cognitive, problem-solving, and homework assignment strategies is consistent with previous research suggesting CBT should emphasize these components as the core.

    “This finding is consistent with previous research 33,37 suggesting CBT should emphasize these components as the core.”
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    Premisecitation

    Zuo and colleagues found that CBT was effective for managing sleep disturbances and improving sleep quality in participants with T2DM.

    “Similarly, Zuo and colleagues 61 found that CBT was effective for managing sleep disturbances and improving sleep quality in participants with T2DM.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [61]

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  • Classified as probably not a substantial claim. May combine two claims.

    Interpretationreasoning

    Through CBT, patients' non-adaptive cognition thoughts could be restructured, leading to subsequent health-related behaviors' changes, which are conducive for T2DM patients.

    “Through CBT, patients' non-adaptive cognition thoughts could be restructured, leading to their subsequent health-related behaviors' changes, which are conducive for T2DM patients.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationcitation

    A CBT-based intervention, including sleep hygiene education, stimulation control, relaxation, and cognitive reconstruction, could relieve patients' nervousness and help them develop the sleep-wake biological rhythm, improving sleep quality gradually.

    “The possible reason is that a CBT-based intervention, including sleep hygiene education, stimulation control, relaxation, and cognitive reconstruction, could relieve patients' nervousness and help them develop the sleep-wake biological rhythm, improving sleep quality gradually 85 .”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [85]

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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The finding that CBT should emphasize psycho-education, behavioral, cognitive, goal-setting, and homework assignment strategies is consistent with previous research.

    “This finding is consistent with previous research 43,62 demonstrating CBT should emphasize these components as the core strategies in the treatment of patients with TM2D.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [43]

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  • Classified as probably not a substantial claim. May combine two claims.

    Interpretationreasoning

    The manual focuses more on the management of DM rather than on negative emotions, which may explain why CBT is effective in reducing depression when there is no DM-specific manual.

    “The possible reason is that the manual focuses more on the management of DM rather than on negative emotions.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationreasoning

    It takes a relatively short time to improve the mood of patients with diabetes included in this study.

    “and it takes a relatively short time to improve the mood.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Only articles written in English were included.

    “Thirdly, only articles written in English were included.”
    Quote in the paperNot a substantial claim
36 of 36

  • The paper relies on this without support.

    The included studies are sufficiently homogeneous in their definitions and delivery of CBT to be pooled in a single meta-analysis.

    “The intervention program had to be CBT or conducted following the principles of CBT, including both cognitive and behavioral techniques.The intervention program could be separate CBT or CBT with other methods; it could be the face-to-face delivering method or delivered remotely; the intervention form could be individual or group-based.”

  • The paper relies on this without support.

    The control conditions (non-CBT interventions, usual care, waiting list) are equivalent enough to serve as a common comparator.

    “The control conditions could be non-CBT interventions or usual care or waiting list.”

  • The paper relies on this without support.

    The scales used to measure depression, anxiety, distress, quality of life, and sleep quality are comparable enough across studies to be combined using standardized mean differences.

    “The secondary outcomes were psychological variables, including depression, anxiety and distress symptoms, quality of life, and sleep quality, all of which were assessed by the scale scores.”

  • The paper relies on this without support.

    The effect of CBT is not materially confounded by co-interventions in trials where CBT was combined with other methods.

    “the remaining 12 studies 19,34,35,39,42,44,50,51,53,58,60,61 used CBT combined with either aerobic exercise, motivational enhancement therapy, lifestyle intervention, or treatment as usual therapy.”
4 of 4

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Cognitive behavioral and mindfulness-based therapies are successful therapeutic approaches for people with diabetes and psychosocial concerns.

    “Successful therapeutic approaches include cognitive behavioral (330,332,348,349) and mindfulness-based therapies (346,350,351).”

    From 5. Facilitating Positive Health Behaviors and Well-being to Improve Health Outcomes:<i>Standards of Care in Diabetes—2023</i> (2023) · cites this paper as [348]

  • Educational and behavioral intervention strategies, including education, cognitive behavioral therapy, mindfulness-based therapies, and motivational interviewing, have demonstrated benefits for diabetes distress and, to a lesser degree, glycemic outcomes.

    “Several educational and behavioral intervention strategies have demonstrated benefits for diabetes distress and, to a lesser degree, glycemic outcomes, including education, psychological therapies such as cognitive behavioral therapy and mindfulness-based therapies, and health behavior change approaches such as motivational interviewing (348,349,365,366).”

    From 5. Facilitating Positive Health Behaviors and Well-being to Improve Health Outcomes:<i>Standards of Care in Diabetes—2023</i> (2023) · cites this paper as [348]

  • Trials have shown consistent evidence of improvements in depressive symptoms and variable benefits for A1C when depression is simultaneously treated, whether through pharmacological treatment, group therapy, psychotherapy, or collaborative care.

    “Trials have shown consistent evidence of improvements in depressive symptoms and variable benefits for A1C when depression is simultaneously treated (331,392,394), whether through pharmacological treatment, group therapy, psychotherapy, or collaborative care (328,348,349,395,396).”

    From 5. Facilitating Positive Health Behaviors and Well-being to Improve Health Outcomes:<i>Standards of Care in Diabetes—2023</i> (2023) · cites this paper as [348]

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Clarke study's control group is described as both waiting list and placebo

    Minor

    The text identifies study 18 as using a waiting-list control, whereas Table 1 labels Clarke's study 18 control group as placebo.

  • A control-group mean age conflicts with the adult-only eligibility criterion

    Minor

    The review specifies participants aged 18 or above, but the table gives one control group a mean age of 6.40 years. A group whose members are all at least 18 cannot have that mean age.

  • HbA1c subgroup estimate falls outside its reported confidence interval

    Minor

    The reported estimate is −0.25%, but both stated confidence-interval endpoints are lower than −0.25%. The endpoints are also printed in reverse order, so the interval cannot be the reported estimate's 95% CI.

3 of 3

Cites

Flagged first, then by citations

3 of the 86 references couldn’t be matched to a known paper.

Research works printed but not linked: 1

  1. Weinger, 1960, The Impact of a Structured Behavioral Intervention on Poorly Controlled Diabetes: A Randomized Controlled Trial, Arch. Intern. Med., 171, 1990, 10.1001/archinternmed.2011.502 · DOI

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Authors
Li, Y., Storch, E. A., Ferguson, S., Li, L., Buys, N., & Sun, J.
Affiliations
  • Griffith University (AU)
  • Baylor College of Medicine (US)
  • Ningbo First Hospital (CN)
Corresponding author
Sun, Jing
ORCID
Venue
Diabetes Research and Clinical Practice
Publisher
Elsevier BV
Published
2022-07
Volume
189
Pages
109965
ISSN
0168-8227 (ISSN-L)
DOI
10.1016/j.diabres.2022.109965
OpenAlex
W4282967339
Semantic Scholar
5a7ebbbfb1ceab79886f2f47d81ca463aa6791ae
Cited by
47
References
86
Citations by year
2026: 15 · 2025: 14 · 2024: 10 · 2023: 6 · 2022: 2
FWCI
1.14
Type
journal article
Language
en
Open access
Licence
Locations
  • Diabetes Research and Clinical Practice (publishedVersion)
  • PubMed (publishedVersion)
  • Griffith Research Online (submittedVersion, cc-by-nc-nd)
Funders
Griffith University
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
  • Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
Keywords
cognitive behavioral therapy, diabetes mellitus, HbA1c, fasting blood glucose, blood pressure, body mass index, depression, anxiety, sleep quality, quality of life, psychoeducation, goal setting, homework, group intervention
MeSH terms
Anxiety, Anxiety Disorders, Diabetes Mellitus, Humans, Quality of Life, Cognitive Behavioral Therapy

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-09.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-09.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

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