A systematic review and meta-analysis of randomized controlled trials of cognitive behavior therapy for patients with diabetes and depression
Abstract
Objective The aim of this meta-analysis was to systematically examine the efficacy of cognitive behavior therapy (CBT) for diabetic patients who have comorbid depression and to identify which aspects can be improved through intervention.Methods A systematic literature review was performed using multiple databases. The inclusion criteria included randomized controlled trials (RCTs) of CBT that were conducted with diabetes patients with clinically relevant depression. Review Manager version 5.3 was used to obtain pooled results.Results Ten RCTs, with a total sample size of 998 participants, met the inclusion criteria. Compared with control groups, the CBT groups had statistically significant, long-term improvements in depression (standardized mean differences [SMD]=-0.65, 95% confidence interval [CI] (-0.98 to -0.31), P=0.0002), quality of life (SMD=0.29, 95%CI (0.08 to 0.51), P=0.007), fasting glucose (SMD=0.21, 95%CI (0.04 to 0.37), P=0.01) and anxiety (SMD=-0.49, 95%CI (-0.88 to -0.10), P=0.01). No improvements were found in glycemic control or in diabetes-related distress.Conclusions The results of this meta-analysis showed that CBT can be effective in reducing depression symptoms and fasting glucose in diabetes patients with comorbid depression as well as in improving quality of life and anxiety in the long-term. The results showed that CBT can serve as a promising treatment alternative for diabetes patients with comorbid depression.
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Previous meta-analytic evidence suggests CBT may be effective at reducing depression in diabetes.
“Overall, the meta‐analytic evidence to date suggests that CBT may be effective at reducing depression.”
A second 2017 review found that CBT did not have a statistically significant effect on diabetes-related distress.
“Furthermore, only two studies in this review looked at diabetes‐related distress and meta‐analysis showed that CBT did not have a statistically significant effect on this outcome.”
Findings regarding CBT's effects on anxiety and HbA1c in diabetes are mixed.
“However, findings regarding anxiety and HbA1c are mixed.”
No previous reviews exploring CBT in diabetes have placed diabetes-related distress as the primary outcome.
“No previous reviews exploring CBT in diabetes have placed diabetes‐related distress as the primary outcome, meaning that relevant studies are missed.”
Previous reviews were unable to meta-analyse diabetes-related distress outcomes or found no effect of CBT on diabetes-related distress based on two studies.
“This is in contrast with previous reviews that were unable to meta‐analyse diabetes‐related distress outcomes 29 or found no effect of CBT on diabetes‐related distress based on two studies. 30”
These previous reviews considered anxiety alongside general depression as the primary outcome which may account for mixed findings.
“These previous reviews considered anxiety alongside general depression as the primary outcome 30 , 31 which may account for these mixed findings.”
Previous reviews have included three to eight studies that measure anxiety.
“In contrast with our review, previous reviews have included three 29 , 30 to eight 31 studies that measure anxiety.”
The pooled effect estimate for depression was small, contrasting with the moderate to large effect estimates seen in previous reviews.
“However, it is important to note that the pooled effect estimate was small, contrasting with the moderate 29 , 30 to large 31 effect estimates seen in previous reviews.”
In two of these previous reviews, depression was the primary outcome.
“In two of these previous reviews depression 30 , 31 was the primary outcome.”
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- Authors
- Li, C., Xu, D., Hu, M., Tan, Y., Zhang, P., Li, G., & Chen, L.
- Affiliations
- Jilin University (CN)
- Corresponding author
- Chen, Li
- Venue
- Journal of Psychosomatic Research
- Publisher
- Elsevier BV
- Published
- 2017-04
- Volume
- 95
- Pages
- 44-54
- ISSN
- 0022-3999 (ISSN-L)
- OpenAlex
- W2588926131
- Cited by
- 90
- References
- 76
- Citations by year
- 2026: 5 · 2025: 5 · 2024: 8 · 2023: 13 · 2022: 14 · 2021: 10 · 2020: 17 · 2019: 9 · 2018: 8 · 2012: 1
- FWCI
- 1.36
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Psychosomatic Research (publishedVersion)
- PubMed (publishedVersion)
- Funders
- JiLin 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 › Psychological Treatments and Assessments
- Keywords
- cognitive behavioral therapy, diabetes mellitus, depression, comorbid depression, quality of life, anxiety, fasting blood glucose, glycemic control, diabetes distress
- MeSH terms
- Depression, Diabetes Mellitus, Humans, Psychotherapy, Group, Quality of Life, Cognitive Behavioral Therapy, Randomized Controlled Trials as Topic
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