Effects of Cognitive Behavioral Therapy-Based Intervention on Improving Glycaemic, Psychological, and Physiological Outcomes in Adult Patients With Diabetes Mellitus: A Meta-Analysis of Randomized Controlled Trials
Open accessAbstract
BACKGROUND: Patients with diabetes mellitus (DM) have a high risk of secondary physiological and psychological complications. Some interventions based on cognitive behavioral therapy (CBT) have been used to control glucose levels and improve negative emotions of patients with DM. This study was undertaken to provide an overview of the effectiveness of CBT-based interventions for improving glycaemic control, psychological, and physiological outcomes in adult patients with DM. METHODS: Randomized controlled trials (RCTs) published in English and Chinese during 2007 and April 2019 were searched through various electronic databases including PubMed, Cochrane Library, Scopus, Embase, ProQuest Dissertations and Theses, and the Chinese databases (WanFang data and China National Knowledge Infrastructure). The primary outcome variables included glycated haemoglobin (HbA1c), fasting plasma glucose (FPG), depression, and anxiety symptoms. The secondary outcomes were weight and cholesterol. Effect sizes were pooled by random-effects modelling using Comprehensive Meta-Analysis software. Physiotherapy Evidence Database tool was used to assess the quality of all included studies. RESULTS: a group had a better effect on both HbA1c and depression symptoms. In addition, behavioral strategies had a better effect on glycaemic control, and cognitive strategies had a better effect on depression symptoms. There was no difference in the change of FPG, anxiety symptoms, weight, and high-density lipoprotein cholesterol (HDL-C) between CBT-based interventions and the control conditions. CONCLUSIONS: The findings indicate that CBT-based interventions are effective for improving glycaemic control and depression symptoms in adult patients with type 1 DM (T1DM) or type 2 DM (T2DM) with moderate to large effect size. The results of the subgroup analysis suggest that it is necessary to adopt different types and technical components of CBT according to the population and purpose of the treatment in clinical practice. Due to the high heterogeneity of included studies and other limitations, further study including large number of studies is needed to confirm these results.
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No previous reviews exploring CBT in diabetes have placed diabetes-related distress as the primary outcome.
“No previous reviews exploring CBT in diabetes have placed diabetes‐related distress as the primary outcome, meaning that relevant studies are missed.”
From The effectiveness of cognitive behavioural therapy and third-wave cognitive behavioural interventions on diabetes-related distress: A systematic review and meta-analysis (2022) · cites this paper as [31]
The Introduction (page unavailable) describes earlier reviews of CBT in diabetes as focusing on glycaemic control or depression, which supports the claim for the reviews it discusses. It does not establish that no previous review used diabetes-related distress as its primary outcome. (LLM, conf=0.76)
Experimental — accuracy not yet measuredIn two of these previous reviews, depression was the primary outcome.
“In two of these previous reviews depression 30 , 31 was the primary outcome.”
From The effectiveness of cognitive behavioural therapy and third-wave cognitive behavioural interventions on diabetes-related distress: A systematic review and meta-analysis (2022) · cites this paper as [31]
The Methods (Inclusion and Exclusion Criteria; page unavailable) list depression symptoms as a primary outcome. They also list glycaemic control and anxiety symptoms as primary outcomes, so this review does not establish that depression was the sole primary outcome. (LLM, conf=0.90)
Experimental — accuracy not yet measuredPrevious meta-analytic evidence suggests CBT may be effective at reducing depression in diabetes.
“Overall, the meta‐analytic evidence to date suggests that CBT may be effective at reducing depression.”
Findings regarding CBT's effects on anxiety and HbA1c in diabetes are mixed.
“However, findings regarding anxiety and HbA1c are mixed.”
A 2020 review did not include diabetes-related distress.
“Diabetes‐related distress was not included in the review.”
Previous reviews have included three to eight studies that measure anxiety.
“In contrast with our review, previous reviews have included three 29 , 30 to eight 31 studies that measure anxiety.”
The findings diverge from evidence showing that CBT improves glycaemic control with moderate effect and in the short and medium term.
“Our findings diverge from evidence showing that CBT improves glycaemic control with moderate effect 31 and in the short and medium term. 29”
These previous reviews considered anxiety alongside general depression as the primary outcome which may account for mixed findings.
“These previous reviews considered anxiety alongside general depression as the primary outcome 30 , 31 which may account for these mixed findings.”
The pooled effect estimate for depression was small, contrasting with the moderate to large effect estimates seen in previous reviews.
“However, it is important to note that the pooled effect estimate was small, contrasting with the moderate 29 , 30 to large 31 effect estimates seen in previous reviews.”
CBT-based intervention has a significant effect on reducing depression and anxiety symptoms in DM patients.
“Similar to previous research 25,26 , our meta-analysis found a significant effect of CBTbased intervention on reducing depression and anxiety symptoms in DM patients, further validating the effectiveness of CBT for emotion intervention.”
From The efficacy of cognitive behavioral therapy-based intervention on patients with diabetes: a meta-analysis (2022) · cites this paper as [26]
The result that CBT is effective in reducing depression when there is no DM-specific manual is consistent with the conclusions of Yang and colleagues' research on patients with diabetes.
“This result is consistent with the conclusions of research conducted by Yang and colleagues 26 on patients with diabetes.”
From The efficacy of cognitive behavioral therapy-based intervention on patients with diabetes: a meta-analysis (2022) · cites this paper as [26]
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- Authors
- Yang, X., Li, Z., & Sun, J.
- Affiliations
- Capital Medical University (CN)
- Griffith University (AU)
- Corresponding author
- Sun, Jing
- Venue
- Frontiers in Psychiatry
- Publisher
- Frontiers Media SA
- Published
- 2020-07-28
- Volume
- 11
- Pages
- 711-711
- ISSN
- 1664-0640 (ISSN-L)
- PMC
- PMC7399630
- OpenAlex
- W3046121015
- Cited by
- 95
- References
- 59
- Citations by year
- 2026: 13 · 2025: 16 · 2024: 25 · 2023: 19 · 2022: 15 · 2021: 7
- FWCI
- 1.57
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Frontiers in Psychiatry (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Charles Sturt University Research Output (CRO) (submittedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Griffith Research Online (submittedVersion, cc-by)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Keywords
- cognitive behavioral therapy, diabetes mellitus, glycemic control, HbA1c, fasting blood glucose, depression, anxiety, psychological outcomes, type 1 diabetes, type 2 diabetes, behavioral interventions, cholesterol, weight
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