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Psychological interventions to improve glycaemic control in patients with type 1 diabetes: systematic review and meta-analysis of randomised controlled trials.

Winkley K, Ismail K, Landau S, Eisler I

Department of Psychological Medicine, Institute of Psychiatry, King's College London, London SE5 9RJ.

OBJECTIVE: To determine whether psychological interventions have any effect on glycaemic control in people with type 1 diabetes. DESIGN: Systematic review and meta-analysis of psychological therapies to assess their effectiveness in improving glycaemic control in type 1 diabetes. DATA SOURCES: Medline, PsycINFO, Embase, and Cochrane central register of controlled trials searched to September 2004. REVIEW METHODS: All included studies were randomised controlled trials in children (including adolescents) or adults with type 1 diabetes that evaluated the effect of a psychological therapy (counselling, cognitive behaviour therapy, family systems therapy, and psychodynamic therapy) on control of diabetes. Data were extracted on sample size, age, duration of diabetes, type of psychological therapy, its mode of delivery, and type of intervention in control group. MAIN OUTCOME MEASURES: Glycaemic control measured by percentage of glycated haemoglobin and psychological distress. Pooled standardised effect sizes were calculated. RESULTS: 29 trials were eligible for the systematic review and 21 trials for the meta-analysis. In the 10 studies of children and adolescents included in the meta-analysis, the mean percentage of glycated haemoglobin was significantly reduced in those who had received a psychological intervention compared with those in the control group (pooled standardised mean difference -0.35 (95% confidence interval -0.66 to -0.04), equivalent to a 0.48% (0.05% to 0.91%) absolute reduction in glycated haemoglobin. In the 11 studies in adults the pooled standardised mean difference was -0.17 (-0.45 to 0.10), equivalent to 0.22% (-0.13% to 0.56%) absolute reduction in glycated haemoglobin. Psychological distress was significantly lower in the intervention groups in children and adolescents (pooled standardised effect size -0.46, -0.83 to -0.10) but not in adults (-0.25, -0.51 to 0.01). CONCLUSION: Psychological treatments can slightly improve glycaemic control in children and adolescents with diabetes but have no effect in adults.

Published 7 July 2006 in BMJ, 333(7558): 65.
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