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Can Psychological Interventions Improve Glycemic Control in Type 1 Diabetes?

Abstract:
Cognitive behavioral therapy techniques are modestly effective in children and adolescents with diabetes.

Although diabetes is associated with various psychological problems, data on the effectiveness of psychological interventions in improving glycemic control are limited. British investigators performed this systematic review and meta-analysis of randomized trials of psychological interventions in children (16 studies) and adults (13 studies) with type 1 diabetes.

Interventions were categorized as counseling, cognitive behavioral therapy, psychoanalytic therapy, and family systems therapy. In 10 studies of children and adolescents, glycosylated hemoglobin was reduced significantly in the intervention group compared with the control group (absolute reduction, 0.48%). In 11 studies of adults, the reduction was not significant (absolute reduction, 0.22%). For children and adolescents (but not adults), psychological distress was significantly lower in the intervention group than in the control group.

Comment:
The effectiveness of psychological interventions was clinically important — although modest— in children and adolescents, but not in adults. As cognitive behavioral therapy was the most common intervention used, the results support including this approach in treating younger patients with type 1 diabetes. Cognitive behavioral therapy techniques in these studies included relaxation, activity scheduling, problem solving, goal and contract setting, cognitive restructuring, and stress management. At the time of publication, the full text of the original article was available free of charge.

— Keith I. Marton, MD

Published in Journal Watch August 29, 2006

Citation(s):
Winkley K et al. Psychological interventions to improve glycaemic control in patients with type 1 diabetes: Systematic review and meta- analysis of randomised controlled trials. BMJ 2006 Jul 8; 333:65-8

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