Interventions to reduce diabetes-related distress among adults with type 1 or type 2 diabetes: a systematic review and meta-analysis of randomised controlled trials.
Samantha B J Schipper, Thomas Karagiannis, Francesco Zaccardi et al.
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In 30 seconds
This systematic review and meta-analysis of randomised controlled trials assessed interventions to reduce diabetes-related distress in adults with type 1 or type 2 diabetes. It included 248 trials and 55,497 participants. Compared with usual care, psychological interventions reduced distress in both diabetes types: for type 1 diabetes, SMD -0.22 [95% CI -0.35, -0.08]; for type 2 diabetes, SMD -0.31 [95% CI -0.50, -0.13]. Glucose-monitoring devices also reduced distress in type 1 diabetes, and education did so in type 2 diabetes, although certainty varied and most other comparisons showed no clear effect.
Key findings
- Psychological interventions reduced distress versus usual care in type 1 diabetes (SMD -0.22 [95% CI -0.35, -0.08]; GRADE = low).
- In type 2 diabetes, psychological interventions reduced distress (SMD -0.31 [95% CI -0.50, -0.13]; GRADE = very low), as did educational interventions (SMD -0.34 [95% CI -0.56, -0.11]; GRADE = low).
- CGM or intermittently scanned glucose monitoring reduced distress versus standard blood glucose measurement in type 1 diabetes (SMD -0.26 [95% CI -0.41, -0.11]; GRADE = moderate).
- Most other intervention comparisons did not show statistically significant effects.
Why it matters
Diabetes distress is the emotional burden associated with living with and managing diabetes, and this review finds that some intervention categories can reduce it. The findings distinguish results by diabetes type and intervention, while the varying GRADE certainty—particularly very low certainty for psychological interventions in type 2 diabetes—underscores the need to interpret estimated benefits cautiously.
What to keep in mind
Many analysed trials had some concerns or high risk of bias. Evidence certainty ranged from moderate to very low, and heterogeneity or too few studies prevented meta-analysis for several intervention categories.