Global comparison of the effect of non-pharmacological interventions on glycemic control in patients with type 2 diabetes: A network meta-analysis from 107 randomized controlled trials

To investigate the effectiveness of non-pharmacological interventions (NPIs) on glycemic control in patients with type 2 diabetes (T2D) and to provide guidance for clinical healthcare-giver. Network meta-analysis (NMA). Randomized controlled trials comparing the effect of NPIs with usual care, waitlist, or other NPIs on glycemic control in patients with T2D. This NMA was guided by frequentist framework. PubMed, Embase, the Cochrane Library Central Register of Controlled Trials, Cumulated Index to Nursing and Allied Health Literature, and Web of Science were searched from their inception until January 2023. The primary outcome was HbA1c and secondary outcomes were cardiovascular risk scores and related psychosocial scores. Mean differences and standardized mean differences were pooled using NMA. Study quality was assessed with the Confidence in Network Meta-analysis. A total of 107 studies (10,496 participants) were included. The median sample size of the included studies was 64 (range, 10–563) and the median duration was 3 months (range, 1–24). Compared to usual care, all NPIs except acupuncture (MD: −0.28; 95 % CI: −1.02, 0.26) and psychological therapy (MD: −0.29; 95 % CI: −0.66, 0.08) showed significantly differences in improving glycemic control in patients with T2D. And according to the results of surface under the cumulative ranking analysis and Cluster ranking, meditation therapy was considered to the best choice when balancing the efficacy of glycemic control with self-efficacy and diabetes related problems, while nutrition therapy was considered to the best choice when balancing quality of life with risk of cardiovascular complications. These findings validate the efficacy of NPIs for glycemic control in patients with T2D and suggest that healthcare-giver should consider both the efficacy of interventions and the psychosocial needs of patients when developing NPIs programs. •Non-pharmacological interventions have great potential to improve glycemic control compared to usual care.•Meditation could be considered to the best plan balancing glycemic control with self-efficacy and diabetes related problems.•Glycemic control effect and psychosocial needs both should be considered when designing non-pharmacological interventions.