The evaluation of cognitive-behavioral therapy-based intervention on type 2 diabetes patients with comorbid metabolic syndrome: a randomized controlled trial

Abstract

Background Cognitive behavior therapy (CBT) has been applied in intervention research in diabetes patients with satisfying results. However, there was no research on type 2 diabetes (T2DM) patients with comorbidities. This study aimed to investigate the effectiveness of CBT on psychological variables, behavior variables, quality of life, sleep quality, and physical variables among adult T2DM patients with comorbid metabolic syndrome (MS). Methods 281 patients aged 18–75 years were recruited from Ningbo First Hospital in China from October 2021 to March 2022. Patients were randomized to the intervention group (IG, N = 148) or control group (CG, N = 133). Patients in the IG received 12 CBT-based sessions during a six-month intervention time. Patients in the CG received the usual care only. Univariate General Linear Model was used to analyze the effect of CBT-based interventions. The analysis was conducted by SPSS Version 28. Results Results indicated that CBT-based intervention was superior in the following aspects: relieving depression symptoms: IG (4.11 ± 4.35 vs. 1.99 ± 2.12), CG (3.40 ± 3.26 vs. 2.32 ± 1.88), interaction effect (F = 4.074, P = 0.044); enhancing diabetes self-care behaviors: IG (26.79 ± 12.18 vs. 37.49 ± 10.83), CG (25.82 ± 13.71 vs. 31.96 ± 11.72), interaction effect (F = 5.242, P = 0.022); promoting the efficacy of CBT: IG (47.45 ± 6.83 vs. 50.76 ± 4.98), CG (46.74 ± 6.94 vs. 47.87 ± 5.11), interaction effect (F = 5.198, P = 0.023); improving subjective sleep quality: IG (0.93 ± 0.68 vs. 0.69 ± 0.63), CG (1.03 ± 0.72 vs. 1.01 ± 0.68), interaction effect (F = 3.927, P = 0.048). Conclusions The CBT-based intervention was beneficial in improving depression symptoms, diabetes self-care behaviors, the efficacy of CBT, and sleep quality in T2DM patients with comorbid MS. The downtrend of body mass index, systolic blood pressure, diastolic pressure, and glycated hemoglobin was larger in the intervention group but not to a significant level. Trial registration: This study has been prospectively registered at Australia New Zealand Clinical Trials Registry (Registration ID: ACTRN12621001348842 website: https://www.anzctr.org.au/trial/MyTrial.aspx).

The Effectiveness of Cognitive Behavioral Therapy-Based Intervention on Improving Sleep-Related Outcomes for People with Diabetes: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

“… 35 Six studies recruited participants with poor sleep quality at baseline, while one did not indicate. 33 Because the cut-off score of five provides satisfactory diagnostic sensitivity (89.6%) and specificity (86.5%) in distinguishing good from poor sleep quality. 37 However, no theoretical framework model was adopted by our included studies to support the intervention.…”

“… 36 One study used the subscales of the PSQI scale to evaluate subjective sleep quality, sleep latency, sleep duration, and sleep efficiency. 33 …”

“…Three out of seven studies conducted six sessions of CBT in six weeks to three months, 29 , 34 , 35 two studies conducted eight sessions in two months, 30 , 31 and one study conducted 12 sessions in six months. 33 Across all interventions, each session ranged from 20 min to 60 min, with the majority of sessions (n = 4) lasting 40–60 min. Two studies did not report the time per session.…”

“…Sleep quality PSQI p <0.001 (6 months, 12 months) The CBT group had lower PSQI scores than the control group at six months and 12 months, respectively. Yanni Li et al 2023 33 CBT Central hospital Six Months. First two Months: Eight sessions and Later four Months: four sessions Each week for eight week and once a month for four months Each session lasted 20–30 min, and was followed by a test General practitioners Individual 1.Sleep quality 2.…”

“…Two studies, 33 , 34 including 307 participants, reported the time to fall asleep; there was no significant that CBT is beneficial to the time to fall asleep after the intervention, compared to the control group. (effect size=−0.73, 95% CI −1.89 to 0.43, Z = 1.23, p = 0.22, I 2 = 85%).…”