Efficacy of acceptance and commitment therapy for people with type 2 diabetes: systematic review and meta-analysis
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Abstract Aims/Introduction This systematic review and meta‐analysis aimed to investigate the efficacy and safety of acceptance and commitment therapy (ACT) for people with type 2 diabetes mellitus. Materials and Methods Several electronic databases were examined on 16 January 2021, including PubMed, CENTRAL, PsycINFO, International Clinical Trials Registry Platform and ClinicalTrials.gov. Randomized controlled trials were included to compare ACT with usual treatment for people with type 2 diabetes reported in any language. Primary outcome measures were glycated hemoglobin, self‐care ability assessed by the summary of diabetes self‐care activities and all adverse events. The secondary outcome measure was acceptance assessed by the acceptance and action diabetes questionnaire. Results Of 678 publications initially identified, three trials were included in the meta‐analysis. ACT resulted in a reduction in glycated hemoglobin (mean difference −0.62 points lower in the intervention group; 95% confidence interval −1.07 to −0.16; I2 = 0%; low‐quality evidence). In addition, ACT increased the score of the summary of diabetes self‐care activities (mean difference 8.48 points higher in the intervention group; 95% confidence interval 2.16–14.80; high‐quality evidence). Adverse events were not measured in all trials. ACT increased scores of the acceptance and action diabetes questionnaire (mean difference 5.98 points higher in the intervention group; 95% confidence interval, 1.42–10.54; I2 = 43%; low‐quality evidence). Conclusions ACT might reduce glycated hemoglobin, and increase self‐care ability and acceptance among people with type 2 diabetes.
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A previous review found ACT reduced HbA1c by MD -0.62% (95% CI [-1.07, -0.52]).
“which was similar to a previous review (MD: -0.62%; 95% CI [-1.07, -0.52]; Sakamoto et al., 2022).”
From Effectiveness of acceptance and commitment therapy in people with type 2 diabetes mellitus: A systematic review and meta‐analysis. (2024) · cites this paper as Sakamoto et al., 2022
The Results (Primary outcome, HbA1c) report that ACT reduced HbA1c by an MD of −0.62, matching the cited estimate. However, the reported 95% CI is −1.07 to −0.16, not −1.07 to −0.52; Table 1 gives the same interval. (LLM, conf=0.94)
Experimental — accuracy not yet measuredSakamoto et al. (2022) conducted a systematic review which included three studies with 678 participants and investigated short-term beneficial effects of ACT on glycemic control, self-care ability, and acceptance.
“Sakamoto et al. (2022) conducted a systematic review which included three studies with 678 participants and investigated the short-term beneficial effects of ACT on glycemic control, self-care ability, and acceptance.”
From Effectiveness of acceptance and commitment therapy in people with type 2 diabetes mellitus: A systematic review and meta‐analysis. (2024) · cites this paper as Sakamoto et al. (2022)
The Abstract Results report that three trials were included and that ACT improved measures of glycemic control, self-care ability, and acceptance. The Discussion describes the review as assessing short-term efficacy. However, 678 was the number of publications initially identified, not participants; Table 1 reports 232 participants for the HbA1c analysis. (LLM, conf=0.95)
Experimental — accuracy not yet measuredA meta-analysis concluded that ACT interventions may improve the ability of self-care, psychological flexibility and HbA1c in type 2 diabetes.
“A meta-analysis concluded that ACT interventions may improve the ability of self-care, psychological flexibility and HbA1c in type 2 diabetes.33”
From Impact of an Acceptance and Commitment Therapy programme on HbA1c, self-management and psychosocial factors in adults with type 1 diabetes and elevated HbA1c levels: A randomised controlled trial (2023) · cites this paper as [33]
The Results section reports lower HbA1c and higher self-care scores with ACT in people with type 2 diabetes. It also reports increased acceptance, measured by the AADQ; the Outcome measures section defines that measure as acceptance of diabetes-related thoughts, not psychological flexibility. Thus the claim’s psychological-flexibility component is not established by the reported results. (LLM, conf=0.86)
Experimental — accuracy not yet measuredSakamoto et al. (2022) failed to discuss optimal characteristics of effective ACT interventions (content, delivery mode, dosage, and duration).
“Most importantly, this review failed to discuss the optimal characteristics of effective ACT interventions (content, delivery mode, dosage, and duration) and, thus, further exploration is warranted.”
From Effectiveness of acceptance and commitment therapy in people with type 2 diabetes mellitus: A systematic review and meta‐analysis. (2024) · cites this paper as Sakamoto et al. (2022)
The effectiveness of ACT on psychological distress was not evaluated and reported in Sakamoto et al. (2022).
“The effectiveness of ACT on psychological distress was not evaluated and reported.”
From Effectiveness of acceptance and commitment therapy in people with type 2 diabetes mellitus: A systematic review and meta‐analysis. (2024) · cites this paper as Sakamoto et al. (2022)
The findings in our study stand in contrast to those of previous studies on ACT intervention in diabetes.
“Regarding ACT intervention in diabetes, the findings in our study stand in contrast to those of previous studies.”
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- Authors
- Sakamoto, R., Ohtake, Y., Kataoka, Y., Matsuda, Y., Hata, T., Otonari, J., Yamane, A., Matsuoka, H., & Yoshiuchi, K.
- Affiliations
- Kindai University (JP)
- Sakai City Medical Center (JP)
- Kyoto University (JP)
- NHO Kinki Chuo Chest Medical Center (JP)
- Kyushu University (JP)
- International University of Health and Welfare Narita Hospital (JP)
- Kansai Medical University Hospital (JP)
- National Cancer Center Hospital (JP)
- The University of Tokyo (JP)
- Corresponding author
- Sakamoto, Ryo
- ORCID
- Venue
- Journal of Diabetes Investigation
- Publisher
- Wiley
- Published
- 2021-09-27
- Volume
- 13
- Issue
- 2
- Pages
- 262-270
- ISSN
- 2040-1116 (ISSN-L)
- 2040-1124
- PMC
- PMC8847115
- OpenAlex
- W3197906331
- Cited by
- 35
- References
- 30
- Citations by year
- 2026: 2 · 2025: 11 · 2024: 10 · 2023: 9 · 2022: 2 · 2021: 1
- FWCI
- 0.73
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Journal of Diabetes Investigation (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Keywords
- acceptance and commitment therapy, type 2 diabetes, HbA1c, diabetes self-care, acceptance, psychological intervention, adverse events, treatment efficacy
- MeSH terms
- Diabetes Mellitus, Type 2, Glycated Hemoglobin, Humans, Surveys and Questionnaires, Self Care, Acceptance and Commitment Therapy
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