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Systematic review and meta-analysis of randomised controlled trials of psychological interventions to improve glycaemic control in patients with type 2 diabetes
Abstract
Background Adherence difficulties and psychological problems are associated with poor glycaemic control in diabetes. We undertook a systematic review and meta-analysis of psychological therapies to assess their effectiveness in improving glycaemic control in type 2 diabetes.Methods We searched MEDLINE, PsychINFO, EMBASE, and the Cochrane Central Register of Controlled Trials up to January, 2003. Eligible studies were randomised controlled trials that involved people with type 2 diabetes and evaluated a psychological therapy (counselling, cognitive behaviour therapy, or psychodynamic therapy) to improve diabetes control. We extracted the number of participants, their age, duration of diabetes, glycaemic control, type of psychological therapy, its mode of delivery, and type of intervention in the control group. The main outcome was long-term glycaemic control measured by percentage of glycated haemoglobin. Blood glucose concentration, weight, and psychological distress were also measured. Pooled standardised effect sizes were calculated.Findings 25 trials were eligible for the review. In 12 trials, the mean percentage glycated haemoglobin was lower in people assigned a psychological intervention than in the control group (usual care, education, waiting list, or attention control); the pooled mean difference was -0.32 (95% CI -0.57 to -0.07) equivalent to an absolute difference of -0.76%. There were non-significant differences in blood glucose concentration (eight trials; -0.11 [-0.65 to 0.42]) and weight gain (nine trials; 0.37 [-0.18 to 0.93]). Psychological distress was significantly lower in the intervention groups (five trials; -0.58 [-0.95 to -0.20]).Interpretation In type 2 diabetes, there are improvements in long-term glycaemic control and psychological distress but not in weight control or blood glucose concentration in people who receive psychological therapies.
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“Behavioural programmes help to sustain new behaviours, relationships with foods and adherence to dietary advice [66–68].”
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“One such intervention is Cognitive Behavioral Therapy (CBT), which has been shown to improve diabetes self-management programs [3] , [4] and [5] .”
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Sturt, J. A., Taylor, H., Docherty, A., Dale, J. R., & Taylor, L. (2006) · BMC Family Practice · doi:10.1186/1471-2296-7-70 · Cited by 27
House, A. O., Bryant, L. D., Russell, A. M., Wright-Hughes, A. M., Graham, L., Walwyn, R. E. A., Wright, J. M., Hulme, C. T., O'Dwyer, J. L., Latchford, G. J., et al. (2018) · Health Technology Assessment · doi:10.3310/hta22260 · Cited by 27
Psychological Issues in Adults with Type 2 Diabetes
Gonzalez, J. S., Esbitt, S. A., Schneider, H. E., Osborne, P. J., & Kupperman, E. (2011) · Springer eBooks · doi:10.1007/978-1-4419-0029-6_2 · Cited by 30
The Effect of a Hypertension Self-Management Intervention on Diabetes and Cholesterol Control
Powers, B. J., Olsen, M. K., Oddone, E. Ž., & Bosworth, H. B. (2009) · The American Journal of Medicine · doi:10.1016/j.amjmed.2008.12.022 · Cited by 26
Tunsuchart, K., Lerttrakarnnon, P., Srithanaviboonchai, K., Likhitsathian, S., & Skulphan, S. (2020) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph17155564 · Cited by 25
Metadata
- Authors
- Ismail, K., Winkley, K., & Rabe-Hesketh, S.
- Affiliations
- King's College London (GB)
- Venue
- The Lancet
- Publisher
- Elsevier BV
- Published
- 2004-05
- Volume
- 363
- Issue
- 9421
- Pages
- 1589-1597
- ISSN
- 0099-5355 (ISSN-L)
- 0140-6736
- OpenAlex
- W2119408095
- Cited by
- 531
- References
- 62
- Citations by year
- 2026: 9 · 2025: 7 · 2024: 12 · 2023: 10 · 2022: 15 · 2021: 23 · 2020: 20 · 2019: 24 · 2018: 34 · 2017: 31 · 2016: 30 · 2015: 28 · 2014: 31 · 2013: 40 · 2012: 27
- FWCI
- 3.88
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Lancet (publishedVersion)
- PubMed (publishedVersion)
- Research Portal (King's College London) (submittedVersion)
- Funders
- Psychiatry Research Trust
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Keywords
- type 2 diabetes, psychological intervention, glycemic control, HbA1c, cognitive behavioral therapy, psychodynamic psychotherapy, counseling, psychological distress, weight gain, blood glucose, diabetes self-management
- MeSH terms
- Blood Glucose, Body Weight, Diabetes Mellitus, Type 2, Glycated Hemoglobin, Humans, Psychotherapy, Stress, Psychological, Randomized Controlled Trials as Topic
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