Systematic review and meta‐analysis of randomized controlled trials of psychological interventions to improve glycaemic control in children and adults with type 1 diabetes

Winkley, Kirsty; Upsher, Rebecca; Ståhl, Daniel; Pollard, Daniel; Brennan, Alan; Heller, Simon; Ismail, Khalida

doi:10.1111/dme.14264

Cited by 29 publications

(27 citation statements)

References 32 publications

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“…The findings of the current meta-analysis further support the benefits of applying CBT-based interventions in the management of DM. Our results are different from previous meta-analysis which showed CBT had small effect on HbA1c, that CBT-based interventions have moderate effect size on glycaemic control ( 7 ). It is possible we have bigger number of studies than previous studies which may have generate more power than the published study ( 7 ).…”

Section: Discussioncontrasting

confidence: 99%

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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

Yang

Sun

2020

Front. Psychiatry

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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: Twenty-three RCTs comprising 2,619 patients with DM (type 1 and type 2) were included in at least one meta-analysis. The results of the main analysis showed that CBTbased interventions had a better effect on reduced HbA1c (−0.275%, 95% CI: −0.443 to −0.107; p < 0.01) with Hedge's g of 0.466 (95% CI: 0.710-0.189), reduced depression symptoms with average reduction of −2.788 (95% CI: −4.450 to −1.207; p < 0.01) and Hedge's g of 0.966 (95% CI: 1.507-0.426). Twenty-three RCTs comprising 2,619 patients with DM (type 1 and type 2) were included in this meta-analysis. Several mediators of the effect were found through subgroup analysis for HbA1c and

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Section: Discussioncontrasting

confidence: 99%

“…The aggregate meta-analysis did not find reduction in HbA1c for children or adults. While, the network meta-analysis for adults showed that CBT-based interventions have potential positive effects on HbA1c reduction ( 7 ).…”

Section: Introductionmentioning

confidence: 99%

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

Yang

Sun

2020

Front. Psychiatry

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“…This improvement in glycemic control was comparable with other studies of psychological treatments to support diabetes self-management. 33 An RCT of face-to-face CBT conducted by the same investigators observed a reduction in HbA1c of 5.5 mmol/mol. 13 Our findings are comparable with those of a feasibility RCT for people with type 1 and type 2 diabetes comparing an online CBT program with therapist support provided by phone and email versus treatment as usual for depression, 21 although the difference was that our inclusion criterion was suboptimal glycemic control, whereas in that study it was depressive symptoms and they included type 2 diabetes.…”

Section: Discussionmentioning

confidence: 99%

Feasibility study of real-time online text-based CBT to support self-management for people with type 1 diabetes: the Diabetes On-line Therapy (DOT) Study

Doherty¹,

Herrmann–Werner²,

Rowe³

et al. 2021

BMJ Open Diab Res Care

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IntroductionThis study examines the feasibility of conducting diabetes-focused cognitive–behavioral therapy (CBT) via a secure online real-time instant messaging system intervention to support self-management and improve glycemic control in people with type 1 diabetes.Research design and methodsWe used a pre–post uncontrolled intervention design over 12 months. We recruited adults with type 1 diabetes and suboptimal glycemic control (HbA1c ≥69 mmol/mol (DCCT 8.5%) for 12 months) across four hospitals in London. The intervention comprised 10 sessions of diabetes-focused CBT delivered by diabetes specialist nurses. The primary outcomes were number of eligible patients, rates of recruitment and follow-up, number of sessions completed and SD of the main outcome measure, change in HbA1c over 12 months. We measured the feasibility of collecting secondary outcomes, that is, depression measured using Patient Health Questionnaire-9 (PHQ-9), anxiety measured Generalised Anxiety Disorder (GAD) and the Diabetes Distress Scale (DDS).ResultsWe screened 3177 patients, of whom 638 were potentially eligible, from whom 71 (11.1%) were recruited. The mean age was 28.1 (13.1) years, and the mean HbA1c was 84.6 mmol/mol (17.8), DCCT 9.9%. Forty-six (65%) patients had at least 1 session and 29 (41%) completed all sessions. There was a significant reduction in HbA1c over 12 months (mean difference −6.2 (2.3) mmol/mol, DCCT 0.6%, p=0.038). The change scores in PHQ-9, GAD and DDS also improved.ConclusionsIt would be feasible to conduct a full-scale text-based synchronized real-time diabetes-focused CBT as an efficacy randomized controlled trial.

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“…Educational interventions use didactic and enhanced learning methods to improve self-management of diabetes by reducing identi able gaps in knowledge [25]. Psychological therapies use the therapeutic alliance between patient and therapist, in which the patient's problems are understood in terms of emotions, cognitions, and behaviors [26], yet, psychological interventions have not proven effective on glycated hemoglobin (HbA1c) in people with type 1 [27] or type 2 diabetes [22]. Health educational tools that aim at translating person-centered care into practice and nding ways to enhance intrinsic motivation may lead to greater long-term behavior change than tools solely relying on external motivation [28].…”

Section: Description Of the Interventionsmentioning

confidence: 99%

Self-determination theory interventions versus usual care in people with diabetes: a protocol for a systematic review with meta-analysis and Trial Sequential Analysis

Mathiesen

Rothmann

Zoffmann

et al. 2020

Preprint

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BackgroundExisting self-management and behavioural interventions for diabetes vary widely in their content, and their sustained long-term effectiveness is uncertain. Autonomy supporting interventions may be a prerequisite to achieve ‘real life’ patient engagement and more long-term improvement through shared decision making and collaborative goal setting. Autonomy supportive interventions aim to promote that the person with diabetes' motivation is autonomous meaning that the person strives for goals they themselves truly believe in and value. This is the goal of self-determination theory and guided self-determination interventions. Self-determination theory has been reviewed but without assessing both benefits and harms and accounting for the risk of random errors using trial sequential analysis. The guided self-determination has not yet been systematically reviewed. The aim of this protocol is to investigate the benefits and harms of self-determination theory-based interventions versus usual care in adults with diabetes.Methods/designWe will conduct the systematic review following The Cochrane Collaboration guidelines. This protocol is reported according to the PRISMA checklist. A comprehensive search will be undertaken in the CENTRAL, MEDLINE, EMBASE, LILACS, PsycINFO, SCI-EXPANDED, CINAHL, SSCI, CPCI-S, and CPCI-SSH to identify relevant trials. We will include randomised clinical trials assessing interventions theoretically based on guided self-determination or self-determination theory provided face-to-face or digitally by any health care professional in any setting. The primary outcomes will be quality of life, mortality, and serious adverse events. The secondary will be diabetes distress, depressive symptoms, and adverse events not considered serious. Exploratory outcome will be glycated haemoglobin and motivation. Outcomes will be assessed at the end of the intervention and at maximum follow-up. The analyses will be performed using Stata version 16 and Trial Sequential Analysis. Two authors will independently screen, extract data from, and perform risk of bias assessment of included studies using the Cochrane risk of bias tool. Certainty of the evidence will be assessed by GRADE.DiscussionSelf-determination theory interventions aim to promote a more autonomous patient engagement and are commonly used. It is therefore needed to evaluate the benefit and harms according to existing trials. Systematic review registration The protocol has been registered in PROSPERO ID nr. CRD42020181144 on the 5th July 2020.

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Systematic review and meta‐analysis of randomized controlled trials of psychological interventions to improve glycaemic control in children and adults with type 1 diabetes

Cited by 29 publications

References 32 publications

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

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

Feasibility study of real-time online text-based CBT to support self-management for people with type 1 diabetes: the Diabetes On-line Therapy (DOT) Study

Self-determination theory interventions versus usual care in people with diabetes: a protocol for a systematic review with meta-analysis and Trial Sequential Analysis

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