Cited by 360Diabetes Management and EducationDiabetes Management and ResearchDiabetes and associated disorders

Psychological interventions to improve glycaemic control in patients with type 1 diabetes: systematic review and meta-analysis of randomised controlled trials

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Winkley, Kirsty, Landau, Sabine, Eisler, Ivan, Ismail, Khalida·2006·BMJ

Abstract

OBJECTIVE: To determine whether psychological interventions have any effect on glycaemic control in people with type 1 diabetes. DESIGN: Systematic review and meta-analysis of psychological therapies to assess their effectiveness in improving glycaemic control in type 1 diabetes. DATA SOURCES: Medline, PsycINFO, Embase, and Cochrane central register of controlled trials searched to September 2004. REVIEW METHODS: All included studies were randomised controlled trials in children (including adolescents) or adults with type 1 diabetes that evaluated the effect of a psychological therapy (counselling, cognitive behaviour therapy, family systems therapy, and psychodynamic therapy) on control of diabetes. Data were extracted on sample size, age, duration of diabetes, type of psychological therapy, its mode of delivery, and type of intervention in control group. MAIN OUTCOME MEASURES: Glycaemic control measured by percentage of glycated haemoglobin and psychological distress. Pooled standardised effect sizes were calculated. RESULTS: 29 trials were eligible for the systematic review and 21 trials for the meta-analysis. In the 10 studies of children and adolescents included in the meta-analysis, the mean percentage of glycated haemoglobin was significantly reduced in those who had received a psychological intervention compared with those in the control group (pooled standardised mean difference -0.35 (95% confidence interval -0.66 to -0.04), equivalent to a 0.48% (0.05% to 0.91%) absolute reduction in glycated haemoglobin. In the 11 studies in adults the pooled standardised mean difference was -0.17 (-0.45 to 0.10), equivalent to 0.22% (-0.13% to 0.56%) absolute reduction in glycated haemoglobin. Psychological distress was significantly lower in the intervention groups in children and adolescents (pooled standardised effect size -0.46, -0.83 to -0.10) but not in adults (-0.25, -0.51 to 0.01). CONCLUSION: Psychological treatments can slightly improve glycaemic control in children and adolescents with diabetes but have no effect in adults.

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  • CBT and other approaches designed to directly reduce distress or diabetes distress have failed to consistently improve clinical outcomes for people with diabetes.

    “Thus, CBT and other approaches designed to directly reduce distress or DD have failed to consistently improve clinical outcomes for people with diabetes (6–8,11).”

    From Addressing emotional distress to improve outcomes in adults with type 1 diabetes: Protocol for ACT1VATE randomized controlled trial (2024) · cites this paper as [11]

    The Discussion and Conclusions report a small improvement in glycaemic control for children and adolescents with type 1 diabetes, but no significant improvement for adults. This supports the claim that clinical benefits were not consistent. The review did not establish that the interventions were designed to directly reduce diabetes distress—its Discussion says only one study targeted people with manifest psychological problems—and it does not cover diabetes beyond type 1. (LLM, conf=0.86)

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  • Cognitive Behavioral Therapy has been shown to improve diabetes self-management programs.

    “One such intervention is Cognitive Behavioral Therapy (CBT), which has been shown to improve diabetes self-management programs [3] , [4] and [5] .”
  • Previous meta-analyses on CBT for DM patients had limitations: some restricted diagnostic types to T1DM or T2DM, one limited participants to non-hospitalized patients, and some did not focus on CBT.

    “However, certain reviews restricted the diagnostic types to T1DM 21 or T2DM 23 , and one review limited the participants to non-hospitalized patients 26 .Furthermore, some reviews did not focus on CBT 21,27 .”

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Research works printed but not linked: 1

  1. [20]20. Bradburn M, Deeks J, Altman D. sbe24: metan-an alternative meta-analysis command. Stata Tech Bull 1998;440:4-15.

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Authors
Winkley, K., Landau, S., Eisler, I., & Ismail, K.
Affiliations
King's College London (GB)
Corresponding author
Ismail, Khalida
Venue
BMJ
Publisher
BMJ
Published
2006-06-27
Volume
333
Issue
7558
Pages
65
ISSN
  • 0007-1447 (ISSN-L)
  • 0959-8138
  • 1468-5833
OpenAlex
W2140685328
Cited by
359
References
40
Citations by year
2026: 2 · 2025: 5 · 2024: 8 · 2023: 8 · 2022: 14 · 2021: 9 · 2020: 18 · 2019: 22 · 2018: 21 · 2017: 11 · 2016: 26 · 2015: 19 · 2014: 32 · 2013: 27 · 2012: 28
FWCI
3.17
Type
journal article
Language
en
Open access
Locations
  • BMJ (publishedVersion)
  • Europe PMC (PubMed Central) (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • Research Portal (King's College London) (submittedVersion)
  • HighWire Press Open Archive (submittedVersion)
Funders
Yale University
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Diabetes and associated disorders
Keywords
type 1 diabetes, psychological intervention, glycemic control, HbA1c, psychological distress, cognitive behavioral therapy, counseling, systemic family therapy, psychodynamic psychotherapy, children and adolescents, adults
MeSH terms
Adult, Diabetes Mellitus, Type 1, Hemoglobins, Abnormal, Humans, Hyperglycemia, Psychotherapy, Stress, Psychological, Randomized Controlled Trials as Topic, Treatment Outcome, Publication Bias

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