Psychological interventions for diabetes‐related distress in adults with type 2 diabetes mellitus

Background Many adults with type 2 diabetes mellitus (T2DM) experience a psychosocial burden and mental health problems associated with the disease. Diabetes‐related distress (DRD) has distinct effects on self‐care behaviours and disease control. Improving DRD in adults with T2DM could enhance psychological well‐being, health‐related quality of life, self‐care abilities and disease control, also reducing depressive symptoms. Objectives To assess the effects of psychological interventions for diabetes‐related distress in adults with T2DM. Search methods We searched the Cochrane Library, MEDLINE, Embase, PsycINFO, CINAHL, BASE, WHO ICTRP Search Portal and ClinicalTrials.gov. The date of the last search was December 2014 for BASE and 21 September 2016 for all other databases. Selection criteria We included randomised controlled trials (RCTs) on the effects of psychological interventions for DRD in adults (18 years and older) with T2DM. We included trials if they compared different psychological interventions or compared a psychological intervention with usual care. Primary outcomes were DRD, health‐related quality of life (HRQoL) and adverse events. Secondary outcomes were self‐efficacy, glycosylated haemoglobin A1c (HbA1c), blood pressure, diabetes‐related complications, all‐cause mortality and socioeconomic effects. Data collection and analysis Two review authors independently identified publications for inclusion and extracted data. We classified interventions according to their focus on emotion, cognition or emotion‐cognition. We performed random‐effects meta‐analyses to compute overall estimates. Main results We identified 30 RCTs with 9177 participants. Sixteen trials were parallel two‐arm RCTs, and seven were three‐arm parallel trials. There were also seven cluster‐randomised trials: two had four arms, and the remaining five had two arms. The median duration of the intervention was six months (range 1 week to 24 months), and the median follow‐up period was 12 months (range 0 to 12 months). The trials included a wide spectrum of interventions and were both individual‐ and group‐based. A meta‐analysis of all psychological interventions combined versus usual care showed no firm effect on DRD (standardised mean difference (SMD) ‐0.07; 95% CI ‐0.16 to 0.03; P = 0.17; 3315 participants; 12 trials; low‐quality evidence), HRQoL (SMD 0.01; 95% CI ‐0.09 to 0.11; P = 0.87; 1932 participants; 5 trials; low‐quality evidence), all‐cause mortality (11 per 1000 versus