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

摘要: Background Many adults with type 2 diabetes mellitus (T2DM) experience a psychosocial burden and mental health problems associated the disease. Diabetes-related distress (DRD) has distinct effects on self-care behaviours disease control. Improving DRD in T2DM could enhance psychological well-being, health-related quality of life, abilities control, also reducing depressive symptoms. Objectives To assess interventions for diabetes-related T2DM. Search methods We searched Cochrane Library, MEDLINE, Embase, PsycINFO, CINAHL, BASE, WHO ICTRP Search Portal ClinicalTrials.gov. The date last search was December 2014 BASE 21 September 2016 all other databases. Selection criteria We included randomised controlled trials (RCTs) (18 years older) T2DM. We if they compared different or intervention usual care. Primary outcomes were DRD, life (HRQoL) adverse events. Secondary self-efficacy, glycosylated haemoglobin A1c (HbA1c), blood pressure, complications, all-cause mortality socioeconomic effects. Data collection analysis Two review authors independently identified publications inclusion extracted data. classified according to their focus emotion, cognition emotion-cognition. performed random-effects meta-analyses compute overall estimates. Main results We 30 RCTs 9177 participants. Sixteen parallel two-arm RCTs, seven three-arm trials. There cluster-randomised trials: two had four arms, remaining five arms. median duration six months (range 1 week 24 months), follow-up period 12 0 months). wide spectrum both individual- group-based. A meta-analysis combined versus care showed no firm effect (standardised mean difference (SMD) -0.07; 95% CI -0.16 0.03; P = 0.17; 3315 participants; trials; low-quality evidence), HRQoL (SMD 0.01; -0.09 0.11; 0.87; 1932 5 (11 per 1000 11 1000; risk ratio (RR) 1.01; 0.17 6.03; 0.99; 1376 3 evidence) events (17 41 RR 2.40; 0.78 7.39; 0.13; 438 evidence). saw small beneficial self-efficacy HbA1c at medium-term (6 months): SMD 0.15 (95% 0.00 0.30; 0.05; 2675 6 favour interventions; there (MD) -0.14% -0.27 0.00; 3165 interventions. Our did not report complications effects. Many high bias incomplete outcome data as well possible performance detection biases subjective questionnaire-based assessment, some appeared be selective reporting. are awaiting further classification. These cognition-focused emotion-cognition focused another 18 ongoing trials, likely focusing cognition, assessing such self-management support, telephone-based cognitive behavioural therapy, stress management web application problem solving management. Most these have community setting based USA. Authors' conclusions Low-quality evidence that none would improve more than Low-quality is available improved after This means we uncertain about outcomes. However, probably substantial More high-quality research emotion-focused programmes, non-US non-European settings low- middle-income countries, needed.