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Psychosocial research
Psychological interventions to improve glycemic control in adults with type 2 diabetes: a systematic review and meta-analysis
  1. Kirsty Winkley1,
  2. Rebecca Upsher2,
  3. Daniel Stahl3,
  4. Daniel Pollard4,
  5. Alan Brennan4,
  6. Simon R Heller5,
  7. Khalida Ismail2
  1. 1Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King’s College London, London, UK
  2. 2Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
  3. 3Department of Biostatistics, King’s College London, London, UK
  4. 4School of Health and Related Research, Health Economics and Decision Science, University of Sheffield, Sheffield, UK
  5. 5Department of Oncology & Metabolism, University of Sheffield, Sheffield, UK
  1. Correspondence to Dr Kirsty Winkley; kirsty.winkley{at}kcl.ac.uk

Abstract

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 (I2=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.

  • type 2 diabetes
  • psychology
  • randomized controlled trial
  • meta-analysis
https://creativecommons.org/licenses/by/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.

https://doi.org/10.1136/bmjdrc-2019-001150

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    Footnotes

    • Contributors KW and KI conceived the study, and DS, SRH and AB made substantial contributions to the study design. RU conducted the literature search. KW and RU acquired the study data. RU, DS and DP conducted the data analysis. KW, RU, DS and DP interpreted the data. RU and DS produced the figures. KW wrote the manuscript, with substantial contributions, critical review and revision of the manuscript from RU, DS and KI. DP, SRH and AB provided critical review and revision of the manuscript. All authors provided final approval for the publication of the manuscript. All authors agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of the work are appropriately investigated and resolved.

    • Funding This work was supported by the National Institute for Health Research (NIHR) Health Technology Assessment (HTA) Evidence Synthesis Programme, UK (grant number 12/213/10). The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care. The funders had no role in study design, data collection, analysis, interpretation, or writing of the report.

    • Competing interests KW has served as a consultant or speaker for MSD and Valotech. SRH has served as a consultant for Lilly, Novo Nordisk, Takeda, Boehringer Ingelheim, MannKind, Sanofi, Zealand Pharma and UN-EEG. He is a recipient of an award from the NIHR to evaluate a complex intervention, DAFNEplus, designed to improve glycemic control in adults with type 1 diabetes. KI has received honorarium for educational lectures for Janssen, Sanofi, Eli Lilly and Novo Nordisk.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information.