Psychological interventions have small benefits on self-care, glucose control
medwireNews: Psychological interventions might have a small positive effect on improving self-care and glucose control in patients with type 2 diabetes, but not for relieving diabetes-related distress, suggest findings from The Cochrane Library.
But there is still uncertainty surrounding the evidence for these outcomes, which was of low quality due to the inclusion of studies that were small, had missing data, and design limitations, the reviewers explain.
They identified 30 randomized controlled trials involving 9177 patients. The duration of intervention, which included both individual and group therapy, was a median of 6 months, ranging from 1 week to 24 months and the median follow-up period was 12 months.
A meta-analysis of all psychological interventions combined showed a small but significant 0.15 standard deviations improvement in self-efficacy over a median of 10 months, compared with usual care, and an average 0.14% lower glycated hemoglobin level over a median of 11 months.
“The small difference of effects is a valid consideration when developing psychological interventions in resource-challenged health facilities,” Boon How Chew (University Medical Center Utrecht, the Netherlands) and colleagues comment.
However, psychological interventions had no “firm” effect on levels of diabetes-related distress and health-related quality of life, with nonsignificant standardized mean differences of –0.07 and 0.01, respectively. Similarly, there was no difference between psychological interventions and usual care for all-cause mortality, with rates of 11 per 1000 patients for each group.
Although variations in comparator groups across the trials meant the researchers were unable to draw conclusions on the effects of specific treatment types, they note that “brief and simple emotion-cognition focused interventions showed the best improvement in self-efficacy when compared to usual care.”
They add: “This beneficial effect was sustained when we pooled only trials with a low overall risk of bias.”
By comparison, glycated hemoglobin levels improved with any type of psychological intervention, but from their findings the team suggests that patients younger than 60 years of age might benefit more from emotion-cognition or cognition-focused interventions than older patients, and that longer and more advanced cognition-focused interventions may have the strongest effect.
The researchers report “reassuring” findings that adverse events were not significantly increased among patients participating in psychological interventions, at 41 per 1000 patients versus 17 per 1000 patients among those receiving usual care.
Noting that evidence on diabetes-related complications and socioeconomic impacts was “non-existent,” the researchers call for examination of these factors “in order to better inform existing practices and policy-makers considering development and implementation of such interventions.”
By Lucy Piper
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