Abstract
China has the largest number of type 2 diabetes mellitus (T2DM) cases globally, and T2DM management has become a critical public health issue in China. Individuals with T2DM have an increased risk of developing mental health disorders, psychological disturbances, and functional problems associated with living with their condition. Previous systematic reviews have demonstrated that, generally, psychological interventions are effective in the management of T2DM-related outcomes; however, these reviews have predominantly included studies conducted within English-speaking countries and have not determined the efficacy of the varying types of psychological interventions. As such, this paper aims to synthesize evidence and quantify the efficacy of psychological therapies for the management of glycemic and psychological outcomes of T2DM in China, relative to control conditions. A systematic search (MEDLINE, PsycINFO, CINAHL, Cochrane Central Register of Controlled Trials, China National Knowledge Infrastructure, and Wangfang Data) for all years to December 2014 identified all available literature. Eligibility criteria included: peer-reviewed journal articles, randomized controlled trials (RCTs) assessing the efficacy of a psychological therapy for the management of T2DM, adult participants (≥18 years) diagnosed with T2DM or non-insulin-dependent diabetes mellitus, and Chinese speaking participants only (in mainland China). Outcome measures were glycated hemoglobin, blood glucose concentration, depression, anxiety, and quality of life. Effect sizes were pooled using a random effects model. Negative effect sizes corresponded to positive outcomes favoring the intervention. Forty-five RCTs were eligible for the meta-analyses. Cognitive behavioral therapy (CBT) and motivational interviewing (MI) were more effective than the control condition in the reduction of glycated hemoglobin [CBT: -0.97 (95% CI -1.37 to -0.57); MI: -0.71 (95% CI -1.00 to -0.43)]. CBT and client-centered therapy (CCT) were also associated with reductions in depression and blood glucose concentration, and CBT was associated with reductions in anxiety. Psychological interventions, namely, CBT, MI, and CCT are effective in improving certain T2DM-related outcomes in China. Considerable levels of heterogeneity and unclear risk of bias associated with most included RCTs suggest caution when interpreting results. In China, where the burden of T2DM is increasing significantly, psychological interventions may provide promising approaches to assist in the management of T2DM to delay the progression of T2DM related outcomes.
Highlights
Type 2 diabetes mellitus (T2DM) is a complex metabolic condition that requires effective long-term management in order for patients to achieve optimal glycemic control and to prevent chronic complications [1]
It is widely recognized that compared to the general population, individuals with T2DM have a higher prevalence of clinical and sub-clinical levels of depression and anxiety [6, 7], with the potential consequences being reductions in glycemic control, quality of life, and treatment adherence [7, 8]
This paper presents the first systematic review and meta-analyses of psychological interventions for the management of glycemic and psychological outcomes of T2DM in China that uses both international and Chinese-language databases, in order to quantify the efficacy of interventions relative to control conditions
Summary
Type 2 diabetes mellitus (T2DM) is a complex metabolic condition that requires effective long-term management in order for patients to achieve optimal glycemic control and to prevent chronic complications [1]. Evidence-based guidelines recognize the importance of a structured and systematic approach to the management of T2DM in the primary care setting that incorporates psychological care within clinical recommendations [3,4,5]. Type 2 diabetes mellitus in China has reached epidemic proportions and has largely been attributed to the rapid urbanization China has experienced over the past two decades. This urbanization has triggered significant improvements in living conditions and socioeconomic status for Chinese residents and has resulted in reductions in physical activity and increases in high energy, high fat diets, body mass index, and central upper-body adiposity [9]. Recent data suggests that 96.3 million adults in China have DM, and this figure is expected to rise to 142.7 million by 2035 if no action is taken [10]
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