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Psychological interventions to improve glycaemic control in patients with type 1 diabetes: systematic review and meta-analysis of randomised controlled trials
Open accessAbstract
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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“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]
Experimental — accuracy not yet measuredIn the citing paper
“One such intervention is Cognitive Behavioral Therapy (CBT), which has been shown to improve diabetes self-management programs [3] , [4] and [5] .”
In the citing paper
“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 .”
From The efficacy of cognitive behavioral therapy-based intervention on patients with diabetes: a meta-analysis (2022) · cites this paper as [21]
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Metadata
- 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
- PMC
- PMC1489251
- 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
- bronze
- doi.org
- 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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