Cognitive behavioural therapy and glycaemic control in diabetes mellitus

Diabetes is a chronic and progressive disease with physical, social and psychological consequences. Mental health problems are more common in people with diabetes and can make self-care more difficult. Cognitive behavioural therapy (CBT) has been effective in treating a variety of psychological disorders and by using it in diabetes, it may help patients improve their HbAic by changing the way they think and behave. The objectives of this review were to examine whether CBT improves glycaemic control and well-being in adults with diabetes mellitus, and to provide an up-to-date systematic review of published research into the effects of CBT interventions on glycaemic control in this population. Electronic searches of MEDLINE, CINAHL (Cumulative Index to Nursing and Allied Health Literature), the Cochrane Collaboration and PsycINFO databases were performed to identify relevant studies on adults with either type 1 or 2 diabetes mellitus, published in English, since 1997. A meta-analysis was carried out on selected studies. Eight studies reported in 10 articles were identified as eligible for detailed review, including six randomised controlled trials, one prospective cohort study and one quasi-experimental design. Three study protocols were also considered. Several studies showed improvements in glycaemic control after CBT, but few found these to be statistically significant, except in subjects with particular co-morbidities. Meta-analysis confirmed no overall statistically significant impact on glycaemic control. Depression and other psychological outcomes improved in most cases. Further research is needed to identify particular groups of patients who might benefit from targeted CBT intervention both physiologically and psychologically, and to identify which interventions are both practical and cost effective. Copyright (C) 2012 John Wiley & Sons.