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Diabet Med. 2020 Feb 5. doi: 10.1111/dme.14264. [Epub ahead of print]

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

Author information

1
Florence Nightingale Faculty of Nursing and Midwifery.
2
Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience.
3
Department of Biostatistics, Institute of Psychiatry, King's College London, London.
4
School of Health and Related Research, University of Sheffield.
5
Department of Oncology & Metabolism, University of Sheffield School of Medicine, Sheffield, UK.

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 [HbA1c (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 HbA1c [adults, nine RCTs, n = 1102, pooled mean difference -0.12, 95% confidence intervals (CI) -0.27 to -0.03, I2 = 29.0%, P = 0.19; children, 20 RCTs, n = 2567, -0.05, 95% CI -0.24 to 0.14, I2  = 79.9%, P > 0.001]. 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.

PMID:
32022290
DOI:
10.1111/dme.14264

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