Yang Xiangyun, Li Zhanjiang, Sun Jing
The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China.
Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China.
Front Psychiatry. 2020 Jul 28;11:711. doi: 10.3389/fpsyt.2020.00711. eCollection 2020.
Patients with diabetes mellitus (DM) have a high risk of secondary physiological and psychological complications. Some interventions based on cognitive behavioral therapy (CBT) have been used to control glucose levels and improve negative emotions of patients with DM. This study was undertaken to provide an overview of the effectiveness of CBT-based interventions for improving glycaemic control, psychological, and physiological outcomes in adult patients with DM.
Randomized controlled trials (RCTs) published in English and Chinese during 2007 and April 2019 were searched through various electronic databases including PubMed, Cochrane Library, Scopus, Embase, ProQuest Dissertations and Theses, and the Chinese databases (WanFang data and China National Knowledge Infrastructure). The primary outcome variables included glycated haemoglobin (HbA1c), fasting plasma glucose (FPG), depression, and anxiety symptoms. The secondary outcomes were weight and cholesterol. Effect sizes were pooled by random-effects modelling using Comprehensive Meta-Analysis software. Physiotherapy Evidence Database tool was used to assess the quality of all included studies.
Twenty-three RCTs comprising 2,619 patients with DM (type 1 and type 2) were included in at least one meta-analysis. The results of the main analysis showed that CBT-based interventions had a better effect on reduced HbA1c (-0.275%, 95% CI: -0.443 to -0.107; p < 0.01) with Hedge's g of 0.466 (95% CI: 0.710 - 0.189), reduced depression symptoms with average reduction of -2.788 (95% CI: -4.450 to -1.207; p < 0.01) and Hedge's g of 0.966 (95% CI: 1.507 - 0.426). Twenty-three RCTs comprising 2,619 patients with DM (type 1 and type 2) were included in this meta-analysis. Several mediators of the effect were found through subgroup analysis for HbA1c and depression symptoms. The interventions emphasising completion homework assignments, stress management, and that used an interpersonal strategy delivered a group had a better effect on both HbA1c and depression symptoms. In addition, behavioral strategies had a better effect on glycaemic control, and cognitive strategies had a better effect on depression symptoms. There was no difference in the change of FPG, anxiety symptoms, weight, and high-density lipoprotein cholesterol (HDL-C) between CBT-based interventions and the control conditions.
The findings indicate that CBT-based interventions are effective for improving glycaemic control and depression symptoms in adult patients with type 1 DM (T1DM) or type 2 DM (T2DM) with moderate to large effect size. The results of the subgroup analysis suggest that it is necessary to adopt different types and technical components of CBT according to the population and purpose of the treatment in clinical practice. Due to the high heterogeneity of included studies and other limitations, further study including large number of studies is needed to confirm these results.
糖尿病患者有发生继发性生理和心理并发症的高风险。一些基于认知行为疗法（CBT）的干预措施已被用于控制糖尿病患者的血糖水平并改善其负面情绪。本研究旨在概述基于CBT的干预措施对改善成年糖尿病患者血糖控制、心理和生理结局的有效性。
通过包括PubMed、Cochrane图书馆、Scopus、Embase、ProQuest学位论文数据库以及中文数据库（万方数据和中国知网）在内的各种电子数据库，检索2007年至2019年4月期间以英文和中文发表的随机对照试验（RCT）。主要结局变量包括糖化血红蛋白（HbA1c）、空腹血糖（FPG）、抑郁和焦虑症状。次要结局为体重和胆固醇。使用综合荟萃分析软件通过随机效应模型汇总效应量。使用物理治疗证据数据库工具评估所有纳入研究的质量。
至少一项荟萃分析纳入了23项RCT，共2619例1型和2型糖尿病患者。主要分析结果表明，基于CBT的干预措施对降低HbA1c有更好的效果（-0.275%，95%CI：-0.443至-0.107；p<0.01），Hedge's g为0.466（95%CI：0.710 - 0.189），对减轻抑郁症状有更好的效果，平均减轻-2.788（95%CI：-4.450至-1.207；p<0.01），Hedge's g为0.966（95%CI：1.507 - 0.426）。本荟萃分析纳入了23项RCT，共2619例1型和2型糖尿病患者。通过对HbA1c和抑郁症状的亚组分析发现了几种效应介导因素。强调完成家庭作业、压力管理以及采用人际策略的干预措施对HbA1c和抑郁症状均有更好的效果。此外，行为策略对血糖控制有更好的效果，认知策略对抑郁症状有更好的效果。基于CBT的干预措施与对照条件在FPG、焦虑症状、体重和高密度脂蛋白胆固醇（HDL-C）变化方面无差异。
研究结果表明，基于CBT的干预措施对改善1型糖尿病（T1DM）或2型糖尿病（T2DM）成年患者的血糖控制和抑郁症状有效，效应量为中到大型。亚组分析结果表明，在临床实践中，有必要根据治疗人群和目的采用不同类型和技术成分的CBT。由于纳入研究的高度异质性和其他局限性，需要包括大量研究的进一步研究来证实这些结果。
