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

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

doi:10.1111/dme.14264

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

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

Research output: Contribution to journal › Review article › peer-review

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Abstract

Aim: We conducted a systematic review aggregate and network meta-analysis of psychological interventions for people with type 1 diabetes to assess their effectiveness in improving glycaemic levels. Methods: We searched the following databases from 1 January 2003 to 1 July 2018: MEDLINE, CINAHL, PsycINFO, Embase, Cochrane Controlled Trials, Web of Science, clinicaltrials.gov, Dissertation Abstract International. We included randomized controlled trials (RCT) of psychological interventions for children and adults with type 1 diabetes reported in any language. We extracted data on publications, participant characteristics at baseline, intervention and control group, and data for the primary outcome, change in glycaemic control [HbA _1c (mmol/mol/%)]. Study authors were contacted for missing data. The review was registered with international prospective register of systematic reviews registration (PROSPERO) CRD42016033619. Results: Twenty-four adult RCTs and 23 of children with type 1 diabetes were included in the systematic review. In aggregate meta-analysis there was no overall effect of psychological intervention compared with control on HbA _1c [adults, nine RCTs, n = 1102, pooled mean difference −0.12, 95% confidence intervals (CI) −0.27 to 0.03, I ² = 29.0%, P = 0.19; children, 20 RCTs, n = 2567, −0.09, 95% CI −0.22 to 0.04, I ²=54.0% P=0.002]. Network meta-analysis suggested that probability and rank-ordering of effectiveness is highest for attention control groups (b = −0.47, 95% CI −0.80 to −0.12) followed by cognitive behavioural therapy (CBT) (−0.26, 95% CI −0.45 to −0.06) compared with usual care for adults. Conclusions: Overall psychological interventions for children and adults with type 1 diabetes do not improve glycaemic control. For adults, CBT-based interventions have the potential to be effective.

Original language	English
Pages (from-to)	735-746
Number of pages	12
Journal	Diabetic Medicine
Volume	37
Issue number	5
Early online date	10 Mar 2020
DOIs	https://doi.org/10.1111/dme.14264
Publication status	Published - 1 May 2020

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Systematic Review or Meta-Analysis_WINKLEY_Accepted3February2020_GOLD VoR (CC BY)Final published version, 1.09 MBLicence: CC BY

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

abstract = "Aim: We conducted a systematic review aggregate and network meta-analysis of psychological interventions for people with type 1 diabetes to assess their effectiveness in improving glycaemic levels. Methods: We searched the following databases from 1 January 2003 to 1 July 2018: MEDLINE, CINAHL, PsycINFO, Embase, Cochrane Controlled Trials, Web of Science, clinicaltrials.gov, Dissertation Abstract International. We included randomized controlled trials (RCT) of psychological interventions for children and adults with type 1 diabetes reported in any language. We extracted data on publications, participant characteristics at baseline, intervention and control group, and data for the primary outcome, change in glycaemic control [HbA 1c (mmol/mol/%)]. Study authors were contacted for missing data. The review was registered with international prospective register of systematic reviews registration (PROSPERO) CRD42016033619. Results: Twenty-four adult RCTs and 23 of children with type 1 diabetes were included in the systematic review. In aggregate meta-analysis there was no overall effect of psychological intervention compared with control on HbA 1c [adults, nine RCTs, n = 1102, pooled mean difference −0.12, 95% confidence intervals (CI) −0.27 to 0.03, I 2 = 29.0%, P = 0.19; children, 20 RCTs, n = 2567, −0.09, 95% CI −0.22 to 0.04, I 2=54.0% P=0.002]. Network meta-analysis suggested that probability and rank-ordering of effectiveness is highest for attention control groups (b = −0.47, 95% CI −0.80 to −0.12) followed by cognitive behavioural therapy (CBT) (−0.26, 95% CI −0.45 to −0.06) compared with usual care for adults. Conclusions: Overall psychological interventions for children and adults with type 1 diabetes do not improve glycaemic control. For adults, CBT-based interventions have the potential to be effective. ",

author = "Kirsty Winkley and Rebecca Upsher and Daniel Stahl and Daniel Pollard and Alan Brennan and Simon Heller and Khalida Ismail",

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T1 - Systematic review and meta‐analysis of randomized controlled trials of psychological interventions to improve glycaemic control in children and adults with type 1 diabetes

AU - Winkley, Kirsty

AU - Upsher, Rebecca

AU - Stahl, Daniel

AU - Pollard, Daniel

AU - Brennan, Alan

AU - Heller, Simon

AU - Ismail, Khalida

PY - 2020/5/1

Y1 - 2020/5/1

N2 - Aim: We conducted a systematic review aggregate and network meta-analysis of psychological interventions for people with type 1 diabetes to assess their effectiveness in improving glycaemic levels. Methods: We searched the following databases from 1 January 2003 to 1 July 2018: MEDLINE, CINAHL, PsycINFO, Embase, Cochrane Controlled Trials, Web of Science, clinicaltrials.gov, Dissertation Abstract International. We included randomized controlled trials (RCT) of psychological interventions for children and adults with type 1 diabetes reported in any language. We extracted data on publications, participant characteristics at baseline, intervention and control group, and data for the primary outcome, change in glycaemic control [HbA 1c (mmol/mol/%)]. Study authors were contacted for missing data. The review was registered with international prospective register of systematic reviews registration (PROSPERO) CRD42016033619. Results: Twenty-four adult RCTs and 23 of children with type 1 diabetes were included in the systematic review. In aggregate meta-analysis there was no overall effect of psychological intervention compared with control on HbA 1c [adults, nine RCTs, n = 1102, pooled mean difference −0.12, 95% confidence intervals (CI) −0.27 to 0.03, I 2 = 29.0%, P = 0.19; children, 20 RCTs, n = 2567, −0.09, 95% CI −0.22 to 0.04, I 2=54.0% P=0.002]. Network meta-analysis suggested that probability and rank-ordering of effectiveness is highest for attention control groups (b = −0.47, 95% CI −0.80 to −0.12) followed by cognitive behavioural therapy (CBT) (−0.26, 95% CI −0.45 to −0.06) compared with usual care for adults. Conclusions: Overall psychological interventions for children and adults with type 1 diabetes do not improve glycaemic control. For adults, CBT-based interventions have the potential to be effective.

AB - Aim: We conducted a systematic review aggregate and network meta-analysis of psychological interventions for people with type 1 diabetes to assess their effectiveness in improving glycaemic levels. Methods: We searched the following databases from 1 January 2003 to 1 July 2018: MEDLINE, CINAHL, PsycINFO, Embase, Cochrane Controlled Trials, Web of Science, clinicaltrials.gov, Dissertation Abstract International. We included randomized controlled trials (RCT) of psychological interventions for children and adults with type 1 diabetes reported in any language. We extracted data on publications, participant characteristics at baseline, intervention and control group, and data for the primary outcome, change in glycaemic control [HbA 1c (mmol/mol/%)]. Study authors were contacted for missing data. The review was registered with international prospective register of systematic reviews registration (PROSPERO) CRD42016033619. Results: Twenty-four adult RCTs and 23 of children with type 1 diabetes were included in the systematic review. In aggregate meta-analysis there was no overall effect of psychological intervention compared with control on HbA 1c [adults, nine RCTs, n = 1102, pooled mean difference −0.12, 95% confidence intervals (CI) −0.27 to 0.03, I 2 = 29.0%, P = 0.19; children, 20 RCTs, n = 2567, −0.09, 95% CI −0.22 to 0.04, I 2=54.0% P=0.002]. Network meta-analysis suggested that probability and rank-ordering of effectiveness is highest for attention control groups (b = −0.47, 95% CI −0.80 to −0.12) followed by cognitive behavioural therapy (CBT) (−0.26, 95% CI −0.45 to −0.06) compared with usual care for adults. Conclusions: Overall psychological interventions for children and adults with type 1 diabetes do not improve glycaemic control. For adults, CBT-based interventions have the potential to be effective.

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U2 - 10.1111/dme.14264

DO - 10.1111/dme.14264

M3 - Review article

SN - 0742-3071

VL - 37

SP - 735

EP - 746

JO - Diabetic Medicine

JF - Diabetic Medicine

IS - 5

ER -

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

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