The effectiveness of psychological interventions on mental health and quality of life in people living with type 1 diabetes: a systematic review and meta-analysis

Agathoklis Efthymiadis; Marianthi Bourlaki; Anastasios Bastounis

doi:10.1007/s13340-021-00564-9

The effectiveness of psychological interventions on mental health and quality of life in people living with type 1 diabetes: a systematic review and meta-analysis

Diabetol Int. 2022 Jan 28;13(3):513-521. doi: 10.1007/s13340-021-00564-9. eCollection 2022 Jul.

Authors

Agathoklis Efthymiadis¹, Marianthi Bourlaki², Anastasios Bastounis³

Affiliations

¹ Division of General Medicine, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, OX3 9DU UK.
² Division of Acute General Medicine, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, OX3 9DU UK.
³ Division of Epidemiology and Public Health, City Hospital, University of Nottingham, Nottingham, NG5 1PB UK.

Abstract

Background: Living with type 1 diabetes can be associated with significant psychological morbidity, poor glycaemic control, and increased risk for microvascular complications. This systematic review sought to investigate the effects of psychological interventions on depression, anxiety, diabetes-related distress, quality of life, and glycaemic control in people with type 1 diabetes.

Methods: Eight electronic databases were searched for published and unpublished randomised controlled trials. Screening, data extraction, and risk of bias assessment (using the Cochrane Collaboration tool for assessing risk of bias 2.0) were independently undertaken by two study authors. The results of the studies were meta-analysed, implementing a random-effects model. The Grading of Recommendations Assessment and Development and Evaluation (GRADE) system was used to determine the confidence in the effect estimates.

Results: Twenty studies were identified. Non-significant standardised mean differences (SMD) were found for depression symptoms (SMD = - 0.17, 95% CI [- 0.41, 0.07], p = 0.16) and diabetes-related distress (SMD = - 0.12, 95% CI [- 0.27, 0.04], p = 0.13). Significant SMD was found for quality of life (SMD = 0.27, 95% CI [0.11, 0.42], p = 0.0007). Significant mean difference (MD) was found for HbA1c (MD = - 0.26, 95% CI [- 0.51, - 0.01], p = 0.04). Prespecified subgroup analysis for cognitive behaviour-based interventions showed significant improvement for HbA1c (MD = - 0.23, 95% CI [- 0.44, - 0.02], p = 0.03).

Conclusions: Psychological interventions were found to significantly increase quality of life and promote glucose control in people with type 1 diabetes. Depending on their cost-effectiveness, psychological interventions could be incorporated in routine clinical practice for people with type 1 diabetes and concomitant psychological morbidity.

Supplementary information: The online version contains supplementary material available at 10.1007/s13340-021-00564-9.

Keywords: Anxiety; Depression; Diabetes-related distress; Glycaemic control; Type 1 diabetes.