Effectiveness of acceptance and commitment therapy in people with type 2 diabetes mellitus: A systematic review and meta‐analysis.

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

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).”

• cites Sakamoto et al., 2022 sourcePartly supported

  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 measured

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

Methodological quality was assessed using ROB 2.0, with two reviewers independently assessing risk of bias and disagreements resolved by consensus.

“The methodological quality of included studies was assessed using the revised Cochrane tool for assessment of the risk of bias (ROB 2.0; Sterne et al., 2019).”

• Also stated in: § Quality appraisal · plain

  “Two reviewers independently assessed the risk of bias and all disagreements were discussed to reach a consensus.”

• cites Sterne et al., 2019 sourceSupported

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

Cohen's kappa was calculated to assess agreement between reviewers.

“Cohen's kappa was calculated by SPSS 25.0 (McHugh, 2012) to assess the degree of agreement between the two reviewers.”

• cites McHugh, 2012 sourceSupported

Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.

Participants need sufficient time to embrace positive values, internalize psychological flexibility, strive for value-oriented goals, and demonstrate alleviated psychological distress.

“It is plausible that participants need sufficient time to embrace positive values, internalize psychological flexibility, strive for the value-oriented goals, and demonstrate alleviated psychological distress(McVay et al., 2019).”

• cites McVay et al., 2019 sourcePartly supported

  The Abstract (page unavailable) says an intervention may be ineffective if its dose is too small, and the Intended Dose section (page unavailable) treats duration as a dose parameter. This supports the general possibility that intervention duration matters, but the paper does not link sufficient time to embracing values, developing psychological flexibility, pursuing value-oriented goals, or alleviating psychological distress. (LLM, conf=0.79)

  Experimental — accuracy not yet measured

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

Approximately 10%-40% of patients with diabetes experience depression, anxiety, or psychological distress due to worry when complications progress, self-care tasks become demanding, and frustration grows regarding uncontrolled blood glucose.

“Approximately 10%-40% of patients with diabetes experience depression, anxiety, or psychological distress due to worry when complications progress, self-care tasks become demanding, and frustration grows regarding uncontrolled blood glucose (IDF, 2021;Sun et al., 2016).”

• cites IDF, 2021Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

• cites Sun et al., 2016 sourcePartly supported

  Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

  Experimental — accuracy not yet measured

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

The review was conducted and reported following the PRISMA-2020 statement.

“This review was conducted and reported following the Preferred Reporting Items for Systematic and Meta-Analysis (PRISMA-2020) statement (Page et al., 2021).”

• cites Page et al., 2021 sourcePartly supported

  The Abstract identifies PRISMA 2020 as reporting guidance for systematic reviews, supporting the claim that the review was reported following it. The Scope of the guideline says PRISMA 2020 is not intended to guide systematic review conduct, so the cited statement does not support the 'conducted following' part. The source also cannot verify whether this particular review adhered to the guideline. (LLM, conf=0.88)

  Experimental — accuracy not yet measured

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

Previous trials and reviews suggested that psychological interventions were effective in improving diabetes-related knowledge, modifying illness perceptions, and enhancing self-efficacy.

“Previous trials and reviews suggested that these psychological interventions were effective in improving patients' diabetes-related knowledge, modifying illness perceptions, and enhancing self-efficacy (Chew et al., 2017).”

• cites Chew et al., 2017 sourcePartly supported

  The Discussion (page unavailable) reports improved self-efficacy compared with usual care, although the authors’ conclusions describe the benefit as small and uncertain. The Background discusses changing illness perceptions as a proposed mechanism, not an established intervention effect; the passages found do not report improved diabetes-related knowledge. (LLM, conf=0.88)

  Experimental — accuracy not yet measured

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

Three studies reported their intervention protocols or manuals.

“Three studies reported their intervention protocols or manuals (Gregg et al., 2007;Shayeghian et al., 2016;Whitehead et al., 2017).”

• cites Gregg et al., 2007 sourceNot checked — no full text of the source
• cites Shayeghian et al., 2016 sourceSupported
• cites Whitehead et al., 2017 sourceNot checked — no full text of the source

Classified as probably not a substantial claim.

Sakamoto 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.”

• cites Sakamoto et al. (2022) sourceSupported

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

There is general agreement that technology can allow equitable access to care, facilitate professional-patient interaction, and facilitate provision of personalized and tailored interventions.

“There is general agreement that technology can allow equitable access to care, facilitate professional-patient interaction, and facilitate the provision of personalized and tailored interventions (Kelson et al., 2019).”

• cites Kelson et al., 2019 sourcePartly supported

  The Abstract’s Background says internet-delivered ACT was developed to overcome financial, geographical, and attitudinal barriers to anxiety treatment. The Results and Discussion describe therapist-guided programs and interventions tailored to specific groups. The paper does not establish a general agreement about technology, equitable access to care, or improved professional–patient interaction; its discussion is narrower, concerning internet-delivered ACT for anxiety. (LLM, conf=0.85)

  Experimental — accuracy not yet measured

May combine two claims.

Sakamoto 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.”

• cites Sakamoto et al. (2022) sourcePartly supported

  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 measured

May combine two claims.

The mean difference of diabetes acceptance improved by 8.47 immediately after intervention and 7.12 at 3-and 6-month follow-up.

“and the mean difference of diabetes acceptance improved by 8.47 immediately after intervention and 7.12 at 3-and 6-month follow-up”

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

The mean age of participants ranged from 47 to 63 years, and the mean duration of diabetes ranged from 4 to 8 years.

“The mean age of participants ranged from 47 to 63 years, and the mean duration of diabetes ranged from 4 to 8 years.”

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

The number and duration of ACT interventions varied among the studies.

“The number and duration of ACT interventions varied among the studies.”

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

Only four studies used theories to guide their intervention development.

“Only four studies used theories to guide their intervention development.”

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

The duration of interventions ranged from 4 weeks to 10 weeks, except one study used a 1-day workshop six and a half hours in length.

“The duration of interventions ranged from 4 weeks to 10 weeks, except in one study which used a 1-day workshop six and a half hours in length (Whitehead et al., 2017).”

• cites Whitehead et al., 2017 sourceNot checked — no full text of the source

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

Interventions of the included studies covered the six core topics of ACT.

“Interventions of the included studies covered the six core topics of ACT.”

The quote only partly states this claim.

ACT interventions with more than five sessions induced significant beneficial effects on self-care behaviors among patients with T2DM.

“ACT interventions with more than five sessions induced significant beneficial effects on glycemic control and self-care behaviors among patients with diabetes.”

• Also stated in: § Linking evidence to action · hedged

  “Intensive ACT interventions with more than five sessions and multidisciplinary professional input could be promising in improving beneficial effects both on glycemic control and self-care behaviors among patients with T2DM.”

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

A total of six included studies (60%) took measures to improve fidelity.

“A total of six included studies (60%) took measures to improve fidelity.”

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

ACT interventions with theory underpinnings could yield better effect on glycemic control.

“ACT interventions with theory underpinnings could yield better effect on glycemic control.”

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

Most ACT interventions (n=6) were facilitated by a multidisciplinary team, including psychologists, nurses, endocrinologists, or psychiatrists.

“Most ACT interventions (n = 6) were facilitated by a multidisciplinary team, including psychologists, nurses, endocrinologists, or psychiatrists.”

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

Five studies trained intervenors before the trials to improve integrity and consistency, and one study conducted a pilot study.

“Five studies trained intervenors before the trials to improve the integrity and consistency of the intervention, and one study conducted a pilot study before the commencement of the fullscale study (Almasi et al., 2021).”

• cites Almasi et al., 2021 sourceNot checked — no full text of the source

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

Interrater agreement at each stage was satisfactory with Cohen's kappa over .80.

“Interrater agreement at each stage (e.g., study screening, data extraction, and quality assessment) was all satisfactory with Cohen's kappa (κ) over .80.”

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

Among included studies, control groups of seven received routine care or health education, one received no treatment, and two did not provide relevant information.

“Among the included 10 studies, the control groups of seven studies (70%) received routine care or health education, one study did not receive any treatment, and two studies did not provide relevant information.”

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

The number of intervention sessions ranged from 2 to 10 (45-90 min), with approximately 70% of ACT interventions exceeding five sessions.

“The number of intervention sessions ranged from 2 to 10 (45-90 min), in which approximately 70% of ACT interventions exceeded five sessions.”

May combine two claims.

Both individual-based and group-based ACT interventions demonstrated favorable effects on glycemic control.

“individual (MD: -1.68; 95% CI [-2.18, -1.18], p < .001)and group-based (MD: -0.72; 95% CI [-1.22,0.22], p = .004)formats were effective in improving glycemic control”

• Also stated in: § Linking evidence to action · boosted

  “despite both formats of delivery demonstrating favorable effects.”

The quote only partly states this claim.

ACT interventions with more than five sessions induced significant beneficial effects on glycemic control among patients with T2DM.

“ACT interventions with more than five sessions induced significant beneficial effects on glycemic control and self-care behaviors among patients with diabetes.”

• Also stated in: § Linking evidence to action · hedged

  “Intensive ACT interventions with more than five sessions and multidisciplinary professional input could be promising in improving beneficial effects both on glycemic control and self-care behaviors among patients with T2DM.”

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

The initial search resulted in 11,897 records.

“The initial search resulted in 11,897 records”

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

Five studies reported group-based ACT interventions, whereas two studies adopted individual-based approaches.

“Regarding the format of the intervention, five studies reported group-based ACT interventions, whereas two studies adopted individual-based approaches.”

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

A total of 712 participants from four countries (America, Iran, New Zealand, and China) were included, and most participants were male (53.09%).

“A total of 712 participants from four countries (America, Iran, New Zealand, and China) were included, and most participants were male (53.09%).”

May combine two claims.

ACT could generate beneficial effectiveness on glycemic control, self-care behaviors, acceptance of diabetes, self-efficacy, anxiety, and depression among patients with T2DM.

“Acceptance and commitment therapy could generate beneficial effectiveness on glycemic control, self-care behaviors, acceptance of diabetes, self-efficacy, anxiety, and depression among patients with T2DM.”

Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

Beneficial effects of ACT on self-care behaviors could be attributed to ACT strategies emphasizing meaningful commitment to valued goals.

“The beneficial effects of ACT interventions on self-care behaviors could be attributed to the nature and connotation of ACT strategies, which emphasize meaningful commitment to valued goals.”

• AssumptionRests on an assumption: ACT strategies emphasize meaningful commitment to valued goals.

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

Visual inspection of funnel plot may not be sensitive to capture publication bias due to limited number of studies for each outcome or subgroup.

“Second, visual inspection of the funnel plot may not be sensitive to capture publication bias due to the limited number of studies for each outcome or subgroup.”

May combine two claims.

Psychological burden induces negative appraisal and avoidant attitude and deteriorates patients' motivation and self-efficacy, resulting in resignation, apathy, or disengagement from self-care activities.

“Psychological burden induces a negative appraisal and avoidant attitude and deteriorates patients' motivation and self-efficacy, resulting in resignation, apathy, or disengagement from performing self-care activities (Cheng et al., 2016).”

• cites Cheng et al., 2016 sourceNot checked — no full text of the source

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

The certainty of evidence was assessed using the GRADE tool.

“The certainty of evidence was assessed in five aspects (risk of bias, consistency of effect, imprecision, indirectness, and publication bias) and categorized as high, moderate, low, or very low”

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

Previous systematic reviews declared that brief ACT interventions with less than five sessions were preferable among patients with advanced cancer and parents of children with chronic health conditions.

“In contrast, previous systematic reviews declared that brief ACT interventions with less than five sessions were preferable among patients with advanced cancer and parents of chil-”

• cites Jin et al., 2021 sourceNot checked — no full text of the source
• cites Li et al., 2021Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

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

The small effects in the current review might be the pooled result of intervention effects across study periods rather than only focusing on short-term effect.

“The small effects in the current review might be the pooled result of the intervention effects across the study periods rather than only focusing on the short-term effect.”

May combine two claims.

The certainty of evidence for self-care behaviors was moderate, downgraded due to lack of blinding.

“The grade evidence of this outcome was downgraded to moderate level of study quality due to lacking blinding.”

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

Two reviewers independently screened titles, abstracts, and full texts, with a third reviewer consulted to resolve disagreements.

“After removing the duplicates, two reviewers independently screened the titles, abstracts, and full texts according to the eligible criteria.The third reviewer was consulted to solve disagreements until there was a consensus.”

May combine two claims.

Poor self-care activities are linked with poor glycemic control, high risk of complications, frequent hospital admissions, and impaired quality of life.

“Poor selfcare activities have been linked with poor glycemic control, high risk of diversifying complications, frequent hospital admissions, and impaired quality of life (Saad et al., 2018).”

• cites Saad et al., 2018 sourceNot checked — no full text of the source

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

Individuals who flexibly respond to stressors are more likely to disengage from problematic responses quickly, turn toward adaptive responses, and build behavior repertoires.

“Individuals who flexibly respond to stressors are more likely to disengage from problematic responses quickly, turn toward adaptive responses, and build behavior repertoires (Gloster et al., 2017).”

• cites Gloster et al., 2017 sourceNot checked — no full text of the source

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

Ni et al. (2021) found mindfulness-based intervention could slightly reduce HbA1c by 0.25% (95% CI [-0.43, -0.07]).

“Ni et al. (2021) found that the mindfulness-based intervention could slightly reduce HbA1c by 0.25% (95% CI [-0.43, -0.07]).”

• cites Ni et al. (2021)Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

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

Data were independently extracted by two researchers, with a third reviewer resolving discrepancies.

“The data were independently extracted by two researchers.A third reviewer reviewed all details and resolved discrepancies.”

Probably not a substantial claim: may not pass S2 (checkable), S4 (based). May combine two claims.

Individual-based ACT intervention allows for establishing rapport and engages participant in committed actions with full consideration of individual preferences, priorities, and experiences.

“An individual-based ACT intervention allows for establishing a rapport atmosphere and engages the participant in committed actions with full consideration of their individual preferences, priorities, and experiences.”

May combine two claims.

This enhanced coping encouraged patients to engage in self-care behaviors like healthy eating and regular exercise, leading to better glycemic control.

“In turn, this encouraged patients to engage in self-care behaviors like healthy eating and regular exercise, which would lead to better glycemic control.”

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

The declaration regarding benefits of brief ACT sessions in the two reviews were based on narrative synthesis and subgroup analyses were not performed.

“However, declaration regarding the benefits of brief ACT sessions in the two reviews were based on the narrative synthesis and subgroup analyses were not performed.”

May combine two claims.

ACT could enhance individuals' ability to cope with psychological challenges of diabetes, possibly helping accept burdensome feelings and reduce negative influences.

“ACT could enhance individuals' ability to cope with the psychological challenges (e.g., depression and anxiety) of diabetes, possibly helping to accept burdensome feelings and reduce the negative influences.”

May combine two claims.

Sensitivity analyses supported that the pooled effects of ACT on glycemic control and self-care behaviors remain significant using leave-one-out, indicating robustness.

“Results of the sensitivity analyses supported that the pooled effects of ACT interventions on glycemic control and self-care behaviors remain significant using the leave-one-out approach, indicating the robustness of the pooled estimates.”

May combine two claims.

The overall risk of bias was assessed as some concerns in eight studies and high risk in two studies.

“For overall risk of bias, eight studies were assessed as having some concerns, and two studies were judged as having high risk”

May combine two claims.

Methodological weaknesses of included studies (e.g., small sample sizes and vague information of allocation concealment) might bias intervention effects and affect validity of evidence.

“First, methodological weaknesses of the included studies (e.g., small sample sizes and vague information of allocation concealment) might bias the intervention effects and affect the validity of the evidence.”

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

A protocol of this review has been registered in PROSPERO (Register Number: CRD42021285542).

“A protocol of this review has been registered in PROSPERO (Register Number: CRD42021285542).”

Classified as probably not a substantial claim.

A systematic search was conducted in PubMed, EMBASE, Web of Sciences, Cochrane Library, Scopus, PsycINFO, China National Knowledge Infrastructure (CNKI), Chinese Biology Medical Literature Database (CBM), and Wan Fang Data from inception to June 2023.

“A systematic search was conducted in PubMed, EMBASE, Web of Sciences, Cochrane Library, Scopus, PsycINFO, China National Knowledge Infrastructure (CNKI), Chinese Biology Medical Literature Database (CBM), and Wan Fang Data from inception to June 2023.”

May combine two claims.

The two previous reviews recruited RCTs or non-RCTs, which may compromise generalizability of their findings.

“Moreover, the two previous reviews recruited RCTs or non-RCTs, which may compromise the generalizability of their findings.”

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

Gray literature in Open Gray, Google search operators, and trial registries were also retrieved.

“Gray literature in Open Gray, Google search operators, and trial registries (e.g., International Clinical Trials Registry Platform”