Roberts Max Z, Scheiber Francesca A, Moskovich Ashley A, Merwin Rhonda M
Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, 2400 Pratt St., Durham, NC 27705, USA.
Behav Sci (Basel). 2025 Jun 9;15(6):792. doi: 10.3390/bs15060792.
Diabetes Mellitus (DM) is highly prevalent and carries a significant self-management burden and elevated risk of biopsychosocial sequelae. Psychological flexibility (PF) has been shown to benefit living with and managing chronic health conditions. The present scoping review aimed to synthesize the available evidence on the relationship between PF and factors central to living with and managing DM. A systematic literature search was conducted. Studies were included if they measured psychological (in)flexibility (PI/PF) and/or one of its component processes and sampled individuals with type 1 or type 2 DM. A total of 48 articles were included. Eighteen (37.5%) sampled individuals with T2D, 16 (33.3%) sampled individuals with T1D, and 14 (29.2%) had mixed diagnostic samples. Twenty-nine (60.4%) reported observational studies, and 19 (39.6%) reported 18 intervention studies. Studies were conducted across 17 countries and broadly found that PI/PF were associated with many clinically meaningful DM variables (e.g., HbA1c, diabetes distress, quality of life, and self-management). Intervention studies including individual, group, and digital Acceptance and Commitment Therapy (ACT) interventions showed trends for beneficial change in PI/PF and diabetes outcomes, but some findings were mixed, and many studies were underpowered. Only two studies tested change in PI/PF as a mediator of diabetes-related outcomes, and most studies used the Acceptance and Action Questionnaire, which has been increasingly criticized for poor discriminant validity. Overall, findings show PI/PF are associated with most aspects of living with and managing diabetes and are generally amenable to change through ACT interventions. However, more methodologically rigorous studies are needed to determine whether PI/PF are active change processes in improving diabetes management and outcomes. Six key calls to action are presented to expand and strengthen this important area of research.
糖尿病（DM）非常普遍，带来了巨大的自我管理负担，且生物心理社会后遗症风险升高。心理灵活性（PF）已被证明有利于慢性健康状况的生活和管理。本综述旨在综合关于PF与糖尿病生活和管理核心因素之间关系的现有证据。进行了系统的文献检索。如果研究测量了心理（不）灵活性（PI/PF）和/或其组成过程之一，并对1型或2型糖尿病患者进行抽样，则纳入研究。共纳入48篇文章。18篇（37.5%）对2型糖尿病患者进行抽样，16篇（33.3%）对1型糖尿病患者进行抽样，14篇（29.2%）有混合诊断样本。29篇（60.4%）报告了观察性研究，19篇（39.6%）报告了18项干预性研究。研究在17个国家进行，广泛发现PI/PF与许多具有临床意义的糖尿病变量相关（如糖化血红蛋白、糖尿病困扰、生活质量和自我管理）。包括个体、团体和数字接受与承诺疗法（ACT）干预在内的干预性研究显示，PI/PF和糖尿病结局有有益变化的趋势，但一些结果参差不齐，许多研究的样本量不足。只有两项研究测试了PI/PF的变化作为糖尿病相关结局的中介，大多数研究使用了接受与行动问卷，该问卷因区分效度差而受到越来越多的批评。总体而言，研究结果表明PI/PF与糖尿病生活和管理的大多数方面相关，并且通常可通过ACT干预改变。然而，需要更严格的方法学研究来确定PI/PF是否是改善糖尿病管理和结局的积极变化过程。提出了六项关键行动呼吁，以扩大和加强这一重要研究领域。
