A systematic review and meta-analysis of randomized controlled trials of cognitive behavior therapy for patients with diabetes and depression

Objective: The aim of this meta-analysis was to systematically examine the efficacy of cognitive behavior therapy (CBT) for diabetic patients who have comorbid depression and to identify which aspects can be improved through intervention. Methods: A systematic literature review was performed using multiple databases. The inclusion criteria included randomized controlled trials (RCTs) of CBT that were conducted with diabetes patients with clinically relevant depression. Review Manager version 5.3 was used to obtain pooled results. Results: Ten RCTs, with a total sample size of 998 participants, met the inclusion criteria. Compared with control groups, the CBT groups had statistically significant, long-term improvements in depression (standardized mean differences [SMD] = -0.65, 95% confidence interval [CI] (-0.98 to -031), P = 0.0002), quality of life (SMD = 0.29, 95%CI (0.08 to 0.51), P = 0.007), fasting glucose (SMD = 0.21, 95%CI (0.04 to 037), P = 0.01) and anxiety (SMD = -0.49, 95%CI (-0.88 to -0.10), P = 0.01). No improvements were found in glycemic control or in diabetes-related distress. Conclusions: The results of this meta-analysis showed that CBT can be effective in reducing depression symptoms and fasting glucose in diabetes patients with comorbid depression as well as in improving quality of life and anxiety in the long-term. The results showed that CBT can serve as a promising treatment alternative for diabetes patients with comorbid depression. (C) 2017 Elsevier Inc. All rights reserved.