Diabetes
Diabetes is a chronic condition affecting over 6% of the population in Scotland (1). Over the long-term, high blood glucose levels can lead to other health problems, such as heart disease, stroke, kidney failure, blindness, amputation, and premature death. It is estimated that diabetes and its related complications cost NHS Scotland around £1 billion each year. Diabetes is an important public health consideration, as well as a life-changing health condition for the person.
Diabetes can be classified into several subgroups, the most common being type 1 (T1D), type 2 (T2D) and gestational diabetes (GDM).
T1D can develop at any age, however, it most commonly develops in childhood. When a person has T1D, the body produces little or no insulin and requires daily insulin therapy to manage blood glucose levels (2). Whilst the exact cause is unclear research suggests that some people have a higher likelihood of developing T1D because of their genetics, but it can be triggered by aspects of their environment (3). The management of T1D involves a lifelong commitment to self-management behaviours that aim to keep blood glucose levels within optimal limits to avoid further health problems. These behaviours include blood glucose monitoring, learning how to use technological devices for monitoring and for insulin therapy, taking medications, carbohydrate counting, attending regular appointments, as well as screening for foot, eye care, cardiovascular and renal problems. For children and young people living with T1D, management of the condition requires wider support. Training and education can be helpful for parents, teachers, family members and self-management skills should be introduced to the child gradually. Support for the child at times of transition, such as starting school, changing schools, and moving into adult health services is important.
T2D is the most common type of diabetes, accounting for 88% of cases in Scotland (1). In T2D, people’s bodies don’t produce enough insulin, or the insulin it does produce does not work effectively enough, which leads to high blood glucose levels. Unlike T1D, T2D develops most commonly in adulthood, although its prevalence in childhood is increasing due to rising obesity rates (Obesity). People who are more at risk of developing T2D include those who live with obesity (Obesity), are older, are from certain UK minority ethnic backgrounds, and those with a family history of T2D. The occurrence of T2D is increasing worldwide, due to physical inactivity, poorer diet and an increase in obesity. In many cases, T2D can be prevented, or progression slowed down through targeted self-management and weight management (Obesity). In some cases, diagnosed T2D can be reversed through such changes (diabetes remission). Management of T2D includes supporting people to make lifestyle changes involving regular physical activity and healthy eating, and for most it will require taking medication and for many insulin treatment.
Gestational Diabetes (GDM) is a type of diabetes that starts during pregnancy, resulting in high blood glucose levels and an increased risk of complications for the expectant mother and the baby. Management includes dietary intervention, medication and sometimes insulin treatment during pregnancy. GDM disappears after pregnancy but is linked with an increased risk of developing T2D post-partum in the short-term and later in life for both the mother and child, as well as increased risk of a further GDM diagnosis for future pregnancies.
Living with diabetes at any age can have wide-reaching (psychological, social, behavioural) effects requiring considerable life adjustments, which in turn can have negative impacts on emotional well-being and quality of life.
Children, young people and their families often experience difficulties with adjusting to a diabetes diagnosis, stress related to procedures (such as insulin therapy or routine device changes), difficulties with self-managing blood glucose levels and disruption to family functioning, (Overview | Diabetes (type 1 and type 2) in children and young people: diagnosis and management | Guidance | NICE) (4). Supporting adjustment and self-management, support for family functioning, as well as supporting children and young people to gain increasing independence in management, are key functions of diabetes services and will vary depending on whether the diagnosis is T1D or T2D.
Research shows that people living with diabetes are more likely to experience difficulties with mental health than people without diabetes. People living with diabetes appear to experience higher rates of common mental health difficulties like depression or anxiety (5,6), as well as more specific experiences including fear of hypoglycaemia, fear of complications, eating disorders/ disordered eating (7) and diabetes related distress (DRD) (8). Older adults with diabetes experience disproportionately high rates of depression and depressive symptoms (9). Diabetes distress (DRD) refers to the emotional burden of relentless daily self-management of diabetes, along with the prospect of developing long-term complications. Levels of diabetes distress appear to fluctuate with levels of stress and at points in time, such as post diagnosis or when complications arise. People living with diabetes who also experience poor mental health are more likely to have difficulties self-managing the condition, and this is associated with higher blood glucose levels on average (10). Indeed, high levels of psychological distress is consistently seen in people who have repeated hospital admissions for serious complications of diabetes (such as diabetic ketoacidosis), with young adults, and older people who are depressed (9) being at particularly high-risk (11).
In addition to the impacts of diabetes on mental wellbeing, some research shows that having depression might make it more likely for adults to develop Type 2 diabetes (12). This suggests a potential two-way relationship between mental health difficulties and diabetes. As such psychological adjustment and mental health should be considered when planning health care for those living with diabetes (13-15). People diagnosed with T2D may be more likely to face stigma and discrimination in society, and the healthcare system. This impacts diagnosis, management and complications related to diabetes (16).
Services should provide person-centred psychological care to people living with diabetes based on a shared understanding of the persons difficulties, experiences and their goals for both psychological wellbeing and diabetes self-management. Delivering such care requires knowledge and expertise, which can best be achieved through integrating psychology professionals into diabetes teams. Integrated/collaborative care (13) provides many benefits (17,18) to people living with diabetes (19,20), staff and health systems as a whole, and should be the preferred model of delivering diabetes psychology services.
Recent developments in technological support for blood glucose monitoring and insulin administration, particularly in T1D, has improved the level of blood glucose control possible. This has brought a rapid change in the expectations of people with diabetes and health care professionals around blood glucose control, with a move from a focus on HbA1c outcomes (measure of average blood glucose levels for the last two to three months) to Time in Range (the amount of time blood glucose level is in a recommended target range). It is important to note that most of the existing evidence considered in this review tends to pre-date the widespread introduction of these technological supports and uses HbA1c as an outcome measure of psychosocial interventions. Anecdotal evidence from NHS services for CYP with T1D, suggests that HbA1c has therefore become a less useful proxy measure for the identification of diabetes associated distress going forward.
To date research on psychosocial interventions has frequently conflated T1D and T2D populations and this too may be less valid in future given the advances in blood glucose control for T1D.
In Scotland, 6.2% of the general population are registered in diabetes registers, with 87.8% of all cases diagnosed with type 2 diabetes, and men accounting for the greater proportion of people diagnosed with type 2 diabetes (56.3%). Approximately 6% of people with type 1 diabetes are under 15 years of age and approximately 3% of people with type 2 diabetes are under 40 years of age (1). It is estimated that about 10% of people with diabetes remain undiagnosed particularly for minority ethnic populations (1). The prevalence of type 2 diabetes has increased steadily in Scotland, with levels associated with increasing age and area level deprivation. Up to 500,000 people are at high risk of developing Type 2 diabetes (1). The global prevalence of diabetes in people 60 years and above is 19% which represents 35% of all cases of adult diabetes (21). Clinicians are advised that there are differences in presentation of psychological problems in later life and to consult Delivering Psychological Therapies and Interventions for Older People for further information on factors relevant to practice.
Individuals with a learning disability are at a higher risk of developing Type 2 diabetes than the general population, with Type 2 diabetes rates approximately 8.5%. The odds of having a diagnosis of diabetes were shown to be 2.46 times higher in people with a learning disability compared to the general population (22).
- This information is for commissioners and providers of health care to consider the evidence base for the delivery of interventions for people with diabetes. This information is also for people with diabetes, their families, and carers. This topic page covers approaches for the management of diabetes in children, young people and adults. Full guidance on assessing and managing diabetes can be found in the NICE guideline for the management of type 2 diabetes in adults (Overview | Type 2 diabetes in adults: management | Guidance | NICE) (23), NICE guideline for diagnosis and management of type 1 diabetes in adults (Overview | Type 1 diabetes in adults: diagnosis and management | Guidance | NICE) (24), NICE guideline for the management of diabetes in pregnancy (Overview | Diabetes in pregnancy: management from preconception to the postnatal period | Guidance | NICE) (25) and NICE guideline for diagnosis and management of diabetes (type 1 and type 2) in children and young people (Overview | Diabetes (type 1 and type 2) in children and young people: diagnosis and management | Guidance | NICE) (4), SIGN guideline for the management of diabetes (sign116.pdf) (26) and SIGN Optimising glycaemic control in people with type 1 diabetes (27).
- Exclusions for topic: This topic neither covers other physical health conditions that are associated with diabetes (e.g. obesity (Obesity), hypertension, hyperlipidaemia, and thrombosis) nor the management of complications arising from diabetes. It does not cover the use of psychotropic medicines in diabetes management, nor the use of weight loss interventions to support reversal/remission of diabetes).
The current evidence for psychological interventions for children and young people living with diabetes is more limited than that of adults.
This is in part due to the greater prevalence of Type 2 diabetes in adults, as well as the rapid change in the methods used for self-management, due to the introductions of technologies (such as insulin pumps, continuous glucose monitors and hybrid closed-loop systems). As noted above these rapid improvements in technology assist control of blood glucose levels and mean that HbA1c will become, from here forward, a less useful proxy measure for the identification of diabetes associated distress (28).
For established evidence (from general paediatric populations, which includes Type 1 Diabetes) on the management of common presenting difficulties for CYP with diabetes, e.g. procedural distress, adherence, coping and adjustment, and transitions (paediatric physical health 2015 tables).
Evidence for structured diabetes psychoeducation in CYP with T1D is mixed. A UK study of existing programmes concluded insufficient evidence for structured education (29) in contrast to studies in the USA suggesting effectiveness. UK interventions – in comparison to USA – varied widely in content and were mostly delivered by non-psychology professionals which may explain poorer outcomes.
There is evidence that parenting interventions for parents of CYP with T1D can support parental adjustment, reduce distress and depression and increase seeking positive social support (30), although results are limited.
Family centred approaches (mainly family therapy) are shown to improve glycaemic control, reduce diabetes related family conflict and improve family relationships (31).
Cognitive Behavioural Therapy (CBT) approaches can be delivered via internet packages, in-person or in groups. The interventions tested have often been blended with other psychological interventions such as motivational interviewing or mindfulness. The outcomes for these interventions are varied, especially when combined in integrated or systematic reviews and clinicians are recommended to look at the randomised control trial (RCT) evidence that is most closely related to the presenting population. The impact of interventions tends to be strongest when applied to with people with greater psychological distress. Outcomes include improved self-efficacy and quality of life (32), reduced depression (33) and demonstrate variable improvements in diabetes-related outcomes (32,34).
Motivational interviewing is included in the table as an alternative intervention to help with glycaemic control due to the evidence being less well established (limited number of trials) as identified in a systematic review (35), with small samples sizes and a restricted population (adolescents with T1D).
Although there is significant clinical interest in Acceptance and Commitment Therapy, Compassion Focussed Therapy, and Narrative Therapy in CYP diabetes, there is no RCT level literature to date on these approaches.
NICE and SIGN guidelines (Overview | Type 2 diabetes in adults: management | Guidance | NICE), Overview | Type 1 diabetes in adults: diagnosis and management | Guidance | NICE, sign116.pdf) (23,24,26) recommend structured diabetes education as an integral part of diabetes care, this is supported by moderate to high quality evidence, but the range of interventions included in reviews of structured education programmes and variability in delivery means there is wide variability in outcomes across studies from low to medium effect sizes.
Structured diabetes education aims to improve outcomes through addressing the individual’s health beliefs, optimising metabolic control, addressing cardiovascular risk factors (helping to reduce the risk of complications), facilitating behaviour change (such as increased physical activity, medication adherence and dietary changes), improving quality of life and reducing depression.
Structured diabetes education should include a psychosocial component, (education, skills training, CBT, social support, relaxation, biofeedback, relapse prevention, stress management, relaxation), should cover all major aspects of diabetes self-care and be provided to people with diabetes and their family/carer(s) with annual reinforcement and review. Programmes should meet the criteria laid down by the Department of Health and Diabetes UK Patient Education Working Group, as recommended by NICE (23,24) and SIGN guidelines (26).
There is strong evidence from reviews/meta analyses (36-45) to suggest that Behaviour Change Interventions (BCIs) are effective at improving physical (e.g. HbA1c level) and psychological (e.g. depression and quality of life) outcomes. This evidence also suggests that a number of specific behaviour change techniques may need to be utilised within BCIs that are the most effective at supporting diabetes management, including supporting patients with dietary and physical activity changes, weight loss, and improved glucose management which can also lead to other positive physical health outcomes.
Seven of the nine reviews only included people with T2D; two reviews included studies with people with both T1D and T2D and did not differentiate between T1D and T2D in their analyses (41,45). The findings were broadly similar for these different delivery methods, digital, in person or combination.
Systematic reviews and meta-analyses support delivery of Cognitive Behavioural Therapy (CBT) with individuals with T1D or T2D (46-48).Broadly reviews do not differentiate T1D and T2D within their analyses (46), nor do they differentiate between CBT-based interventions varying in content, duration and provided by multidisciplinary staff, and CBT interventions delivered by a CBT therapist.
When findings on the effectiveness of Cognitive Behavioural Therapy (CBT) and CBT-based interventions for diabetes related distress (DRD), depression, anxiety, glycaemic control, and Quality of Life (QoL) in individuals with T1D or T2D are synthesised (49) the differential effects of therapist delivered CBT interventions and CBT-based interventions can be seen. Across a range of high to low quality systematic reviews CBT-based interventions provided by multidisciplinary staff are effective at reducing depression (medium to large effect sizes), diabetes-related distress (low to medium effect sizes) and HbA1c levels (low to medium effect sizes). CBT-based interventions overall did not reduce anxiety as a secondary outcome, although treatment duration may moderate this relationship and measures for quality of life are too varied to make robust conclusions.
In comparison, high quality RCTs of CBT delivered by a CBT-therapist were more effective at reducing diabetes-related distress and anxiety as a secondary measure, whereas improvements in depressive symptoms and glycaemic control were similar across practice types (effect sizes medium to high).
There is high quality evidence that Motivational Interviewing (50-52) is effective in reducing blood glucose levels (HbA1c), emotional distress and depression (low effect size) in adults with T1D and T2D and increasing self-efficacy (medium effect sizes).
The emerging literature for the application of Acceptance and Commitment Therapy (ACT) and Compassion Focused Therapy (CFT) was reviewed. At present there is little high-quality evidence reporting the efficacy of Acceptance and Commitment Therapy for improving glucose management or mental health outcomes specifically for adults with Type 1 Diabetes, though upcoming controlled trial protocols (53,54) and feasibility trials (55) have been published.
Although there is significant clinical interest in Compassion Focussed Therapy in adult diabetes, there is little literature to date. Only two papers (56,57) were of sufficient quality and only one RCT demonstrated statistical and clinically significant change in depression over time, changes in HbA1c levels were not statistically significant.
Overview of evidence for Older People
Older adults with diabetes have unique psychosocial challenges that impact self-care and glycaemic control and include; depression or anxiety; social factors such loss of independence and removal from home environment, and medical factors such as multiple comorbidities and polypharmacy. These challenges interact and complicate everyday life (9). In the absence of older people specific evidence, the guidance for adults should be followed. Clinicians are advised that there are differences in presentation of psychological problems in later life and to consult The Matrix - Delivering effective psychological therapies and interventions to older people for further information on factors relevant to practice.
|
Recommendation |
Who For? |
What Intervention? |
Type of Psychological Practice |
Level of Evidence |
Level of Efficacy |
| First line recommendation | Psychosocial factors Adolescents with TD1 |
CBT (32)
Internet-delivered CBT (58-60)
In-person CBT (61-63)
CBT based groups (64)
|
Specialist | B |
N/A
Improvements in psychological comorbidities (Self efficacy, QOL, stress, depression)
Mixed findings on physiological outcomes
|
| Depressed female adolescents at risk of developing TD2 |
CBT group intervention (6 sessions) (33,65)
MBCT group intervention (33,66)
|
Specialist | B |
N/A Depression
N/A Stabilised Insulin sensitivity
|
|
| Children and adolescents with TD1 | Family Therapies and interventions (31) | Specialist | B | Low improved metabolic control, reduced diabetes-related conflict, improved family relationships | |
| Parents and carers of children and adolescents with TD1 | Parenting Interventions (supportive parenting training or education programs for parents of children or adolescents with T1D) (30) | Enhanced | B | N/A improves psychosocial adjustment, reduction of parents? depression and distress, increased positively seeking social support |
|
| Alternative recommendation (evidence less well established) | Treatment adherence and glycaemic control in adolescents with TD1 | Motivational Interviewing (35) | Enhanced, Specialist | B | N/A |
|
Recommendation |
Who For? |
What Intervention? |
Type of Psychological Practice |
Level of Evidence |
Level of Efficacy |
| First line intervention | Adults T1D Adults T2D experiencing problems with hypoglycaemia or failing to reach glycaemic targets |
Structured education programmes: including psychosocial component- e.g. X-PERT. (NICE, SIGN (23,24,26,27,67-72) |
Skilled | A |
Medium - HbA1c
Low - QOL, DRD
|
| Adults T1D/T2D | Cognitive behavioural therapy (CBT) based enhanced interventions (36,47) individual or group format, including:
|
Enhanced | A | Low - DRD (36,47) Medium to high - Depression (36,47,48,51,73) |
|
| Adults T1D/T2D | CBT (75,76) | Specialist | A | Medium- DRD (75,76) Medium to high - Depression (75-77) Medium to high - Anxiety (75-77) Low (6 months post-treatment) - HbA1c (78,79) High (post treatment and follow up) - QOL (75,76,80) |
|
| T1D/T2D | Motivational interviewing SIGN (26,50-52,81) | Enhanced/Specialist | A | Low - HbA1c Low - Emotional distress Low - Depression Medium - Self-efficacy |
|
| Active component of psychological interventions | Adults T1D/T2D | Effective behaviour change interventions incorporate a range of BCTs and can be delivered as part of other interventions e.g. motivational interviewing, structured education | Enhanced/Specialist | A | Low - Depression (44) Low to medium - HbA1c (36,41,42,44,82) High - BMI (82) High - Physical activity (82) Medium - QOL (44) |
With thanks to Rose Stewart (NHS Wales) who participated in the technical group and Nikola Jaroma who assisted with references.
Technical group: Mairi Albiston, Hannah Dale, Regina Esiovwa, Cyan Harte, Elizabeth Hunter, Kerstin Hunter, Salla Karki, Kirsty MacLennan,
Nicola McPherson, Shona Murphy, Esther Murray, Leeanne Nicklas, Hanna Press and Marie Claire Shankland.
1.NHS Scotland, Scottish Diabetes Group. Scottish Diabetes Survey 2022. 2022; Available at: https://www.diabetesinscotland.org.uk/wp-content/uploads/2023/10/Scottish-Diabetes-Survey-2022.pdf.
2.International Diabetes Federation. IDF Diabetes Atlas (10th Edition). 2021; Available at: https://diabetesatlas.org/idfawp/resource-files/2021/07/IDF_Atlas_10th_Edition_2021.pdf.
3.Atkinson, Mark A., George S. Eisenbarth, and Aaron W. Michels. Type 1 Diabetes. The Lancet 2014:69–82.
4.National Institute for Health and Care Excellence. Diabetes (Type 1 and Type 2) in Children and Young People: Diagnosis and Management. 2023; Available at: https://www.nice.org.uk/guidance/ng18.
5.Elamoshy R., Bird Y., Thorpe L., Moraros J. Risk of depression and suicidality among diabetic patients: A systematic review and meta-analysis. Journal of Clinical Medicine 2018;7(11) (pagination):Article Number: 445. Date of Publication: 16 Nov 2018.
6.Rotella F., Mannucci E. Diabetes mellitus as a risk factor for depression. A meta-analysis of longitudinal studies. Diabetes Res Clin Pract 2013;99(2):98–104.
7.Broadley M.M., Zaremba N., Andrew B., Ismail K., Treasure J., White M.J., et al. 25 Years of psychological research investigating disordered eating in people with diabetes: what have we learnt?. Diabetic Med 2020;37(3):401–408.
8.Polonsky W.H., Fisher L., Earles J., Dudl R.J., Lees J., Mullan J., et al. Assessing psychosocial distress in diabetes: Development of the Diabetes Distress Scale. Diabetes Care 2005;28(3):626–631.
9.Beverly E.A., Ritholz M.D., Shepherd C., Weinger K. The Psychosocial Challenges and Care of Older Adults with Diabetes: "Can't Do What I Used To Do; Can't Be Who I Once Was". Current Diabetes Reports 2016;16(6) (pagination):Article Number: 48. Date of Publication: 01 Jun 2016.
10.Ducat L., Philipson L.H., Anderson BJ. The mental health comorbidities of diabetes. JAMA 2014;312(7):691–692.
11.GIRFT, Rayman G., Kar P. Diabetes: GIRFT Programme National Specialty Report. 2020; Available at: https://www.gettingitrightfirsttime.co.uk/wp-content/uploads/2020/11/GIRFT-diabetes-report.pdf.
12.Maina J.G., Balkhiyarova Z., Nouwen A., Pupko I., Ulrich A., Boissel M., et al. Bidirectional Mendelian Randomization and Multiphenotype GWAS Show Causality and Shared Pathophysiology Between Depression and Type 2 Diabetes. Diabetes Care 2023;46(9):1707–1714.
13.Coventry P., Lovell K., Dickens C., Bower P., ChewGraham C., McElvenny D., et al. Integrated primary care for patients with mental and physical multimorbidity: Cluster randomised controlled trial of collaborative care for patients with depression comorbid with diabetes or cardiovascular disease. BMJ (Online) 2015;350:1–11.
14.Katon W.J., Lin E.H.B., Korff M.V., Ciechanowski P., Ludman E.J., Young B., et al. Collaborative care for patients with depression and chronic illnesses. N Engl J Med 2010;363(27):2611–2620.
15.Atlantis E., Fahey P., Foster J. Collaborative care for comorbid depression and diabetes: A systematic review and meta-analysis. BMJ Open 2014;4(4) (pagination):Article Number: e004706. Date of Publication: 2014.
16.Liu N.F., Brown A.S., Younge M.F., Guzman S.J., Close K.L., Wood R. Stigma in people with type 1 or type 2 diabetes. Clinical Diabetes 2017;35(1):27–34.
17.The Psychological Professions Network. Maximising the Impact of Psychological Practice in Physical Healthcare: Discussion Paper. 2020.
18.The Kings Fund, Naylor C. DP, Shilpa Ross, Matthew Honeyman, James Thompson, Helen Gilburt. Bringing Together Physical and Mental Health: A New Frontier for Integrated Care. 2016; Available at: https://assets.kingsfund.org.uk/f/256914/x/5fa0a562d8/bringing_together_physical_and_mental_health_march_2016.pdf.
19.Diabetes UK. Too Often Missing: Making Emotional and Psychological Support Routine in Diabetes Care. 2019; Available at: https://www.diabetes.org.uk/resources-s3/2019-05/Full%20Report_Too%20Often%20Missing_Diabetes%20UK_May%202019.pdf.
20.Joensen L., Fisher L., Skinner T., Doherty Y., Willaing I. Integrating psychosocial support into routine diabetes care: perspectives from participants at the Self-Management Alliance meeting 2016. Diabetic Med 2019;36(7):847–853.
21.International Diabetes Federation. IDF Diabetes Atlas (Sixth Edition). 2013; Available at: https://diabetesatlas.org/idfawp/resource-files/2010/07/IDF_diabetes_atlas_sixth_edition_en.pdf.
22.Baksh, R. A., Gulliford, M., Chauhan, U., Sheehan, R., Strydom, A. Onset and Care of Type 2 Diabetes Mellitus in People
with a Learning Disability. 2023; Available at: https://www.kcl.ac.uk/ioppn/assets/fans-dept/diabetes-deep-dive-2022.pdf.
23.National Institute for Health and Care Excellence. Type 2 Diabetes in Adults: Management. 2022; Available at: https://www.nice.org.uk/guidance/ng28.
24.National Institute for Health and Care Excellence. Type 1 Diabetes in Adults: Diagnosis and Management. 2022; Available at: https://www.nice.org.uk/guidance/ng17
25.National Institute for Care and Health Excellence. Diabetes in Pregnancy: Management from Preconception to the Postnatal Period. 2023; Available at: https://www.nice.org.uk/guidance/ng18.
26.Scottish Intercollegiate Guidelines Network. Management of Diabetes: A National Clinical Guideline. 2017; Available at: https://www.sign.ac.uk/assets/sign116.pdf.
27.Scottish Intercollegiate Guidelines Network. Optimising Glycaemic Control in People with Type 1 Diabetes. 2024; Available at: https://www.sign.ac.uk/our-guidelines/optimising-glycaemic-control-in-people-with-type-1-diabetes/.
28.Schoelwer M.J., DeBoer M.D., Breton MD. Use of diabetes technology in children. Diabetologia 2024;67(10):2075–2084.
29.Charalampopoulos D., Hesketh K.R., Amin R., Paes V.M., Viner R.M., Stephenson T. Psycho-educational interventions for children and young people with Type 1 Diabetes in the UK: How effective are they? A systematic review and meta-analysis. PLoS ONE 2017;12(6) (pagination):Article Number: e0179685. Date of Publication: 01 Jun 2017.
30.Zhao X., Ai Z., Chen Y., Wang J., Zou S., Zheng S. The Effectiveness of Parenting Interventions on Psychosocial Adjustment in Parents of Children and Adolescents with Type 1 Diabetes: A Meta-Analysis. Worldviews on evidence-based nursing 2019;16(6):462–469.
31.McBroom L.A., Enriquez M. Review of family-centered interventions to enhance the health outcomes of children with type 1 diabetes. Diabetes Educ 2009;35(3):428–438.
32.Rechenberg K., Koerner R. Cognitive behavioral therapy in adolescents with type 1 diabetes: An integrative review. J Pediatr Nurs 2021;60:190–197.
33.PinhasHamiel O., Hamiel D. Cognitive Behavioral Therapy and Mindfulness-Based Cognitive Therapy in Children and Adolescents with Type 2 Diabetes. Current Diabetes Reports 2020;20(10) (pagination):Article Number: 55. Date of Publication: 01 Oct 2020.
34.Winkley K, Upsher R, Stahl D, Pollard D, Kasera A, Brennan A, et al. Psychological interventions to improve self-management of type 1 and type 2 diabetes: a systematic review. Health Technol Assess 2020;24(28):1–232.
35.DehghanNayeri N., Ghaffari F., Sadeghi T., Mozaffari N. Effects of motivational interviewing on adherence to treatment regimens among patients with type 1 diabetes: A systematic review. Diabetes Spectrum 2019;32(2):112–117.
36.Almulhim A.N., Hartley H., Norman P., Caton S.J., Dogru O.C., Goyder E. Behavioural Change Techniques in Health Coaching-Based Interventions for Type 2 Diabetes: A Systematic Review and Meta-Analysis. BMC Public Health 2023;23(1):95.
37.Avery L., Flynn D., Dombrowski S.U., van Wersch A., Sniehotta F.F., Trenell MI. Successful behavioural strategies to increase physical activity and improve glucose control in adults with Type 2 diabetes. Diabetic Med 2015;32(8):1058–1062.
38.Baradez C., Liska J., BrulleWohlhueter C., Pushkarna D., Baxter M., Piette J. Brief Digital Solutions in Behavior Change Interventions for Type 2 Diabetes Mellitus: A Literature Review. Diabetes Therapy 2022;13(4):635–649.
39.Cradock K.A., OLaighin G., Finucane F.M., Gainforth H.L., Quinlan L.R., Ginis KAM. Behaviour change techniques targeting both diet and physical activity in type 2 diabetes: A systematic review and meta-analysis. International Journal of Behavioral Nutrition and Physical Activity 2017;14(1) (pagination):Article Number: 18. Date of Publication: 08 Feb 2017.
40.Cradock K.A., OLaighin G., Finucane F.M., McKay R., Quinlan L.R., Martin Ginis K.A., et al. Diet behavior change techniques in type 2 diabetes: A systematic review and meta-analysis. Diabetes Care 2017;40(12):1800–1810.
41.Fredrix M., McSharry J., Flannery C., Dinneen S., Byrne M. Goal-setting in diabetes self-management: A systematic review and meta-analysis examining content and effectiveness of goal-setting interventions. Psychol Health 2018;33(8):955–977.
42.Kebede MM, Zeeb H, Peters M, Heise TL, Pischke CR. Effectiveness of Digital Interventions for Improving Glycemic Control in Persons with Poorly Controlled Type 2 Diabetes: A Systematic Review, Meta-analysis, and Meta-regression Analysis. Diabetes Technology & Therapeutics 2018;20(11):767–782.
43.Presseau J., Ivers N.M., Newham J.J., Knittle K., Danko K.J., Grimshaw JM. Using a behaviour change techniques taxonomy to identify active ingredients within trials of implementation interventions for diabetes care. Implementation science : IS 2015;10:55.
44.Upsher R, Onabajo D, Stahl D, Ismail K, Winkley K. The Effectiveness of Behavior Change Techniques Underpinning Psychological Interventions to Improve Glycemic Levels for Adults With Type 2 Diabetes: A Meta-Analysis. Frontiers in Clinical Diabetes & Healthcare 2021;2:699038.
45.van Vugt M., de Wit M., Cleijne W.H., Snoek FJ. Use of behavioral change techniques in web-based self-management programs for type 2 diabetes patients: systematic review. Journal of medical Internet research 2013;15(12):e279.
46.An Q., Yu Z., Sun F., Chen J., Zhang A. The Effectiveness of Cognitive Behavioral Therapy for Depression Among Individuals with Diabetes: a Systematic Review and Meta-Analysis. Current Diabetes Reports 2023;23(9):245–252.
47.Jenkinson E., Knoop I., Hudson J.L., MossMorris R., Hackett RA. The effectiveness of cognitive behavioural therapy and third-wave cognitive behavioural interventions on diabetes-related distress: A systematic review and meta-analysis. Diabetic Med 2022;39(11) (pagination):Article Number: e14948. Date of Publication: 01 Nov 2022.
48.Uchendu C., Blake H. Effectiveness of cognitive-behavioural therapy on glycaemic control and psychological outcomes in adults with diabetes mellitus: a systematic review and meta-analysis of randomized controlled trials. Diabetic Med 2017;34(3):328–339.
49.H. Press. How Effective are CBT and CBT-based Interventions in Type 1 and Type 2 Diabetes: An Umbrella ReviewUniversity of Stirling and Dundee; 2023.
50.Bilgin A., Muz G., Yuce GE. The effect of motivational interviewing on metabolic control and psychosocial variables in individuals diagnosed with diabetes: Systematic review and meta-analysis. Patient Educ Couns 2022;105(9):2806–2823.
51.Chapman A, Liu S, Merkouris S, Enticott JC, Yang H, Browning CJ, et al. Psychological Interventions for the Management of Glycemic and Psychological Outcomes of Type 2 Diabetes Mellitus in China: A Systematic Review and Meta-Analyses of Randomized Controlled Trials. Frontiers in Public Health 2015;3:252.
52.Berhe KK, Gebru HB, Kahsay HB. Effect of motivational interviewing intervention on HgbA1C and depression in people with type 2 diabetes mellitus (systematic review and meta-analysis). PLoS ONE [Electronic Resource] 2020;15(10):e0240839.
53.Amsberg S., Wijk I., Livheim F., Toft E., Johansson U.B., Anderbro T. Acceptance and commitment therapy (ACT) for adult type 1 diabetes management: Study protocol for a randomised controlled trial. BMJ Open 2018;8(11) (pagination):Article Number: e022234. Date of Publication: 01 Nov 2018.
54.Lindholm-Olinder A, Fischier J, Fries J, Alfonsson S, Elvingson V, Eriksson JW, et al. A randomised wait-list controlled clinical trial of the effects of acceptance and commitment therapy in patients with type 1 diabetes: a study protocol. BMC Nursing 2015;14:61.
55.Bendig E., Bauereiss N., Schmitt A., Albus P., Baumeister H. ACTonDiabetes - A guided psychological internet intervention based on Acceptance and Commitment Therapy (ACT) for adults living with type 1 or 2 diabetes: Results of a randomised controlled feasibility trial. BMJ Open 2021;11(7) (pagination):Article Number: e049238. Date of Publication: 09 Jul 2021.
56.Friis A.M., Johnson M.H., Cutfield R.G., Consedine N S, editors. Kindness matters: A randomized controlled trial of a mindful self-compassion intervention improves depression, distress, and HbA>1c>1c> among patients with diabetes. American Diabetes Association Inc. (E-mail: membership@diabetes.org); 2016.
57.Rahmani S, Mansoobifar M, Seirafi MR, Ashayeri H, Bermas H. Effectiveness of Family Empowerment Therapy Based on Self-Compassion on Self-Care and Glycosylated Hemoglobin in Female Patients with Type 2 Diabetes Mellitus: A Randomized Controlled Clinical Trial. Women’s Health Bulletin 2020;7(2):33–42.
58.Lansing A.H., Stanger C., Budney A., Christiano A.S., Casella SJ. Pilot Study of a Web-Delivered Multicomponent Intervention for Rural Teens with Poorly Controlled Type 1 Diabetes. Journal of Diabetes Research 2016;2016(pagination):Article Number: 7485613. Date of Publication: 2016.
59.Stanger C, Lansing AH, Scherer E, Budney A, Christiano AS, Casella SJ. A web-delivered multicomponent intervention for adolescents with poorly controlled type 1 diabetes: A pilot randomized controlled trial. Annals of Behavioral Medicine 2018;52(12):1010–1022.
60.Whittemore R., Liberti L.S., Jeon S., Chao A., Minges K.E., Murphy K., et al. Efficacy and implementation of an Internet psychoeducational program for teens with type 1 diabetes. Pediatric Diabetes 2016;17(8):567–575.
61.Berger G., Brunmayr F., Muehlehner M., Waldhoer T., Wondratsch C., Koenig M., et al, editors. Gender differences in the effect of motivational interviewing and cognitive behavioural therapy in Austrian adolescents with type 1 diabetes. Diabetologia. Conference: 49th Annual Meeting of the European Association for the Study of Diabetes, EASD 2013. Barcelona Spain. 56(SUPPL. 1) (pp S452); Springer Verlag; 2013.
62.Serlachius A.S., Scratch S.E., Northam E.A., Frydenberg E., Lee K.J., Cameron FJ. A randomized controlled trial of cognitive behaviour therapy to improve glycaemic control and psychosocial wellbeing in adolescents with type 1 diabetes. Journal of health psychology 2016;21(6):1157–1169.
63.Wei C, Allen RJ, Tallis PM, Ryan FJ, Hunt LP, Shield JP, et al. Cognitive behavioural therapy stabilises glycaemic control in adolescents with type 1 diabetes-Outcomes from a randomised control trial. Pediatric Diabetes 2018;19(1):106–113.
64.Grey M., Boland E.A., Davidson M., Li J., Tamborlane WV. Coping skills training for youth with diabetes mellitus has long-lasting effects on metabolic control and quality of life. J Pediatr 2000;137(1):107–113.
65.Shomaker LB, Kelly NR, Radin RM, Cassidy OL, Shank LM, Brady SM, et al. Prevention of insulin resistance in adolescents at risk for type 2 diabetes with depressive symptoms: 1-year follow-up of a randomized trial. Depress Anxiety 2017;34(10):866–876.
66.Shomaker LB, Pivarunas B, Annameier SK, Gulley L, Quaglia J, Brown KW, et al. One-Year Follow-Up of a Randomized Controlled Trial Piloting a Mindfulness-Based Group Intervention for Adolescent Insulin Resistance. Frontiers in Psychology 2019;10:1040.
67.Winkley K., Upsher R., Stahl D., Pollard D., Kasera A., Brennan A., et al. Psychological interventions to improve self-management of type 1 and type 2 diabetes: A systematic review. Health Technol Assess 2020;24(28):1–268.
68.Liu F., Guan Y., Li X., Xie Y., He J., Zhou Z.G., et al. Different Effects of Structured Education on Glycemic Control and Psychological Outcomes in Adolescent and Adult Patients with Type 1 Diabetes: A Systematic Review and Meta-Analysis. International Journal of Endocrinology 2020;2020(pagination):Article Number: 9796019. Date of Publication: 2020.
69.Chrvala C.A., Sherr D., Lipman RD. Diabetes self-management education for adults with type 2 diabetes mellitus: A systematic review of the effect on glycemic control. Patient Educ Couns 2016;99(6):926–943.
70.Pirbaglou M., Katz J., Motamed M., Pludwinski S., Walker K., Ritvo P. Personal Health Coaching as a Type 2 Diabetes Mellitus Self-Management Strategy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Am J Health Promot 2018;32(7):1613–1626.
71.Ellis S.E., Speroff T., Dittus R.S., Brown A., Pichert J.W., Elasy TA. Diabetes patient education: A meta-analysis and meta-regression. Patient Educ Couns 2004;52(1):97–105.
72.O'donoghue G., O'sullivan C., Corridan I., Daly J., Finn R., Melvin K., et al. Lifestyle interventions to improve glycemic control in adults with type 2 diabetes living in low-and-middle income countries: A systematic review and meta-analysis of randomized controlled trials (rcts). International Journal of Environmental Research and Public Health 2021;18(12) (pagination):Article Number: 6273. Date of Publication: 02 Jun 2021.
73.Li C., Xu D., Hu M., Tan Y., Zhang P., Li G., et al. A systematic review and meta-analysis of randomized controlled trials of cognitive behavior therapy for patients with diabetes and depression. J Psychosom Res 2017;95:44–54.
74.Dong N, Wang X, Yang L. The short- and long-term effects of cognitive behavioral therapy on the glycemic control of diabetic patients: A systematic review and meta-analysis. BioPsychoSocial Medicine 2023;17(1):ArtID 18.
75.Tovote K.A., Schroevers M.J., Snippe E., Sanderman R., Links T.P., Emmelkamp P.M.G., et al. Long-term effects of individual mindfulness-based cognitive therapy and cognitive behavior therapy for depressive symptoms in patients with diabetes: A randomized trial. Psychother Psychosom 2015;84(3):186–187.
76.Tovote K.A., Fleer J., Snippe E., Peeters A.C.T.M., Emmelkamp P.M.G., Sanderman R., et al. Individual mindfulness-based cognitive therapy and cognitive behavior therapy for treating depressive symptoms in patients with diabetes: Results of a randomized controlled trial. Diabetes Care 2014;37(9):2427–2434.
77.Alshehri M.M., Alenazi A.M., Alothman S.A., Rucker J.L., Phadnis M.A., Miles J.M., et al. Using Cognitive Behavioral Therapy for Insomnia in People with Type 2 Diabetes, Pilot RCT Part I: Sleep and Concomitant Symptom. Behavioral sleep medicine 2021;19(5):652–671.
78.Lustman P.J., Griffith L.S., Freedland K.E., Kissel S.S., Clouse RE. Cognitive behavior therapy for depression in type 2 diabetes mellitus. A randomized, controlled trial. Ann Intern Med 1998;129(8):613–621.
79.Safren S.A., Gonzalez J.S., Wexler D.J., Psaros C., Delahanty L.M., Blashill A.J., et al. A randomized controlled trial of cognitive behavioral therapy for adherence and depression (cbtad) in patientswith uncontrolled type 2 diabetes. Diabetes Care 2014;37(3):625–633.
80.Menting J., Tack C.J., van Bon A.C., Jansen H.J., van den Bergh J.P., Mol M.J.T.M., et al. Web-based cognitive behavioural therapy blended with face-to-face sessions for chronic fatigue in type 1 diabetes: a multicentre randomised controlled trial. The Lancet Diabetes and Endocrinology 2017;5(6):448–456.
81.Mathiesen A.S., Egerod I., Jensen T., Kaldan G., Langberg H., Thomsen T. Psychosocial interventions for reducing diabetes distress in vulnerable people with type 2 diabetes mellitus: A systematic review and meta-analysis. Diabetes, Metabolic Syndrome and Obesity 2019;12:19–33.
82.Avery L., Flynn D., Dombrowski S.U., van Wersch A., Sniehotta F.F., Trenell MI. Successful behavioural strategies to increase physical activity and improve glucose control in adults with Type 2 diabetes. Diabetic Med 2015;32(8):1058–1062.