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

K Winkley,D Pollard,A Brennan,R Upsher,S Heller,K Ismail,D Stahl

doi:10.1111/dme.14264

Abstract

AimWe 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.MethodsWe searched the following databases from 1 January 2003 to 1 July 2018: MEDLINE, CINAHL, PsycINFO, Embase, Cochrane Controlled Trials, Web of Science, https://clinicaltrials.gov, Dissertation 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.ResultsTwenty‐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, 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.ConclusionsOverall 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.

Highlights

Successful self-management of type 1 diabetes involves the acquisition, implementation and maintenance of complex skills including frequent blood glucose monitoring, carbohydrate counting and calculations of insulin dose to achieve optimal glycaemic control and avoid diabetes-related complications
Twenty-four adult randomized controlled trials (RCT) 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 À0.12, 95% confidence intervals (CI) À0.27 to 0.03, I2 = 29.0%, P = 0.19; children, 20 RCTs, n = 2567, À0.09, 95% CI À0.22 to 0.04, I2=54.0% P=0.002]

Summary

Introduction

Successful self-management of type 1 diabetes involves the acquisition, implementation and maintenance of complex skills including frequent blood glucose monitoring, carbohydrate counting and calculations of insulin dose to achieve optimal glycaemic control and avoid diabetes-related complications. Emerging technologies are increasingly available to assist people with type 1 diabetes, selfmanagement remains highly complex and psychologically demanding. It is associated with high levels of psychological comorbidity, such as anxiety [1], depression [2] and eating disorders [3], and these problems are more prevalent in adults and children with diabetes and suboptimal glycaemic control [4,5]. International guidelines [6,7,8], suggest that children and adults with type 1 diabetes should receive screening and psychological support in order to treat common psychological a 2020 The Authors.

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