Systematic Review and Meta-Analysis of Randomised Controlled Trials of Psychological Interventions to Improve Glycaemic Control in Adults with Type 2 Diabetes

Abstract

Background: The quality of evidence that psychological interventions improve glycaemic control for children but not adults with type 1 diabetes (T1D) is weak. We updated an earlier systematic review and meta-analysis of psychological interventions in T1D to assess whether effectiveness in improving glycaemic levels has changed over time. Methods: We applied the protocol of an earlier systematic review and aggregate meta-analysis, conducted to January 2004. We added network meta-analysis (NMA) to compare intervention type. MEDLINE, CINAHL, PsycINFO, EMBASE, Cochrane Controlled Trials, Web of Science, and Dissertation Abstract International were searched January 2003-July 2018. Randomised controlled trials (RCT) of psychological interventions for individuals with T1D reported in any language were included. Data were extracted from study reports and authors contacted for missing data. Primary outcome was change in glycaemic control (glycated haemoglobin, HbA1c (mmol/mol)). Findings: 24 RCTs of adults, 23 of children were included in the updated systematic review. For adults (9 RCTs, n=1,102) the pooled mean difference for people randomised to psychological intervention compared with control group was -0·12 (95% CI -0·27 to -0·03), 2mmol/mol HbA1c reduction, with low heterogeneity (I2 29·0%, p=0·19). For children (20 RCTs, n=2,567) it was -0·05 (95% CI-0·24 to 0·14), 1mmol/mol HbA1c reduction, heterogeneity was high (I2=79·9%, p<0·001). NMA suggested probability and rank-ordering of effectiveness is highest for attention control then cognitive behavioural therapy compared with usual care for adults. Interpretation: Overall there is no evidence that psychological interventions for individuals with T1D improve glycaemic control. Funding Statement: This paper presents independent research funded by the UK’s National Institute for Health Research (NIHR) Health Technology Assessment (HTA) Evidence Synthesis Programme (reference: 12/213/10). Declaration of Interests: KW has served as a consultant or speaker for MSD and Valotech, SRH has served as a consultant for Lilly, Novo Nordisk, Takeda, Boeringher 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 glycaemic control in adults with type 1 diabetes. KI has received honorarium for educational lectures for Jannssen, Sanofi, Eli Lilly and Novo Nordisk. Ethics Approval Statement: The study is registered with PROSPERO, CRD42016033619. The study was also conducted according to PRISMA guidelines.