Systematic review and meta‐analysis of randomized controlled trials of psychological interventions to improve glycaemic control in children and adults with type 1 diabetes. Issue 5 (10th March 2020)

• Record Type: Journal Article
• Authors: Winkley, K.; Upsher, R.; Stahl, D.; Pollard, D.; Brennan, A.; Heller, S.; Ismail, K.
• Is Part Of: Diabetic medicine. Volume 37:Issue 5(2020)
• Page Start: 735
• Page End: 746
• Publication Date: 2020-03-10
• Subjects: Diabetes -- Periodicals; 616.462
• DOI: 10.1111/dme.14264
• Languages: English
• ISSNs: 0742-3071

Abstract

Abstract: Aim: We conducted a systematic review aggregate and network meta‐analysis of psychological interventions for people with type 1 diabetes to assess their effectiveness in improving glycaemic levels. Methods: We searched the following databases from 1 January 2003 to 1 July 2018: MEDLINE, CINAHL, PsycINFO, Embase, Cochrane Controlled Trials, Web of Science, clinicaltrials.gov, Dissertation Abstract International. We included randomized controlled trials (RCT) of psychological interventions for children and adults with type 1 diabetes reported in any language. We extracted data on publications, participant characteristics at baseline, intervention and control group, and data for the primary outcome, change in glycaemic control [HbA1c (mmol/mol/%)]. Study authors were contacted for missing data. The review was registered with international prospective register of systematic reviews registration (PROSPERO) CRD42016033619. Results: Twenty‐four adult RCTs and 23 of children with type 1 diabetes were included in the systematic review. In aggregate meta‐analysis there was no overall effect of psychological intervention compared with control on HbA1c [adults, nine RCTs, n = 1102, pooled mean difference −0.12, 95% confidence intervals (CI) −0.27 to 0.03, I 2 = 29.0%, P = 0.19; children, 20 RCTs, n = 2567, −0.09, 95% CI −0.22 to 0.04, I 2 =54.0% P =0.002]. Network meta‐analysis suggested that probability and rank‐ordering of effectiveness is highest for attention control groups ( b = −0.47, 95% CI −0.80 to −0.12) followed by cognitive behavioural therapy (CBT) (−0.26, 95% CI −0.45 to −0.06) compared with usual care for adults. Conclusions: Overall psychological interventions for children and adults with type 1 diabetes do not improve glycaemic control. For adults, CBT‐based interventions have the potential to be effective. What's new?: A previous systematic review and meta‐analysis of randomized controlled trials (RCT) of psychological interventions to improve glycaemic control demonstrated an effect for children with type 1 diabetes but not adults, with a reduction in HbA1c of 5 mmol/mol (0.5%). The current review synthesized data from nine adult ( n = 1102) and 20 child RCTs ( n = 2567) in an aggregate meta‐analysis; there was no improvement/reduction in HbA1c for children or adults. Network meta‐analysis for adults demonstrated that cognitive behavioural therapy (CBT) and attention control were associated with statistically and clinically significant HbA1c reduction. Psychological interventions are not indicated for improving glycaemic control for people with type 1 diabetes. For adults, CBT‐based interventions have the potential to be effective.