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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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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
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.
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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