TY - JOUR
T1 - Psychological interventions to improve glycemic control in adults with type 2 diabetes
T2 - A systematic review and meta-analysis
AU - Winkley, Kirsty
AU - Upsher, Rebecca
AU - Stahl, Daniel
AU - Pollard, Daniel
AU - Brennan, Alan
AU - Heller, Simon R.
AU - Ismail, Khalida
PY - 2020/4/9
Y1 - 2020/4/9
N2 - The quality of evidence that psychological interventions are effective in improving glycemic control in adults with type 2 diabetes (T2D) is weak. We conducted a systematic review and meta-analysis of psychological interventions in T2D to assess whether their effectiveness in improving glycemic levels has improved over the past 30 years. We applied the protocol of a systematic review and aggregate meta-analysis conducted to January 2003. We added network meta-analysis (NMA) to compare intervention and control group type against usual care. MEDLINE, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, EMBASE, Cochrane Controlled Trials Database, Web of Science, and Dissertation Abstracts International were searched from January 2003 to July 2018. Only randomized controlled trials (RCT) of psychological interventions for adults with T2D reported in any language were included. The primary outcome was change in glycemic control (glycated hemoglobin (HbA1c) in mmol/mol). Data were extracted from study reports and authors were contacted for missing data. 94 RCTs were eligible for inclusion in the systematic review since the last review. In 70 RCTs (n=14 796 participants) the pooled mean difference in HbA1c in those randomized to psychological intervention compared with control group was-0.19 (95% CI-0.25 to-0.12), equivalent to a reduction in HbA1c of 3.7 mmol/mol, with moderate heterogeneity across studies (I 2 =64.7%, p<0.001). NMA suggested the probability of intervention effectiveness is highest for self-help materials, cognitive-behavioral therapy, and counseling, compared with usual care. Limitations of this study include that there is a possibility that some studies may have been missed if diabetes did not appear in the title or abstract. The effectiveness of psychological interventions for adults with T2D have minimal clinical benefit in improving glycemic control. PROSPERO registration number CRD42016033619.
AB - The quality of evidence that psychological interventions are effective in improving glycemic control in adults with type 2 diabetes (T2D) is weak. We conducted a systematic review and meta-analysis of psychological interventions in T2D to assess whether their effectiveness in improving glycemic levels has improved over the past 30 years. We applied the protocol of a systematic review and aggregate meta-analysis conducted to January 2003. We added network meta-analysis (NMA) to compare intervention and control group type against usual care. MEDLINE, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, EMBASE, Cochrane Controlled Trials Database, Web of Science, and Dissertation Abstracts International were searched from January 2003 to July 2018. Only randomized controlled trials (RCT) of psychological interventions for adults with T2D reported in any language were included. The primary outcome was change in glycemic control (glycated hemoglobin (HbA1c) in mmol/mol). Data were extracted from study reports and authors were contacted for missing data. 94 RCTs were eligible for inclusion in the systematic review since the last review. In 70 RCTs (n=14 796 participants) the pooled mean difference in HbA1c in those randomized to psychological intervention compared with control group was-0.19 (95% CI-0.25 to-0.12), equivalent to a reduction in HbA1c of 3.7 mmol/mol, with moderate heterogeneity across studies (I 2 =64.7%, p<0.001). NMA suggested the probability of intervention effectiveness is highest for self-help materials, cognitive-behavioral therapy, and counseling, compared with usual care. Limitations of this study include that there is a possibility that some studies may have been missed if diabetes did not appear in the title or abstract. The effectiveness of psychological interventions for adults with T2D have minimal clinical benefit in improving glycemic control. PROSPERO registration number CRD42016033619.
KW - meta-analysis
KW - psychology
KW - randomized controlled trial
KW - type 2 diabetes
UR - http://www.scopus.com/inward/record.url?scp=85083219938&partnerID=8YFLogxK
U2 - 10.1136/bmjdrc-2019-001150
DO - 10.1136/bmjdrc-2019-001150
M3 - Article
C2 - 32273289
AN - SCOPUS:85083219938
SN - 2052-4897
VL - 8
JO - BMJ Open Diabetes Research & Care
JF - BMJ Open Diabetes Research & Care
IS - 1
M1 - e001150
ER -
