Review: psychological interventions reduce glycated haemoglobin concentrations in type 2 diabetes.

In patients with type 2 diabetes mellitus, do psychological interventions improve glycaemic control?METHODSData sources: Cochrane Central Register of Controlled Trials (issue 4, 2002), Medline (1966 to January 2003), EMBASE/ Excerpta Medico (1980 to January 2003), and PsycINFO (1974 to January 2003); proceedings of conferences on diabetes (1997-2002); reference lists of identified studies and reviews; and leading authors and experts in the field.Study selection and assessment: published or unpublished randomised controlled trials (RCTs) in any language comparing psychological interventions (supportive or counselling therapy, cognitive behaviour therapy, brief psychodynamic therapy, or interpersonal therapy) with usual care, education, waiting list, or attention control in patients a >/=18 years of age with type 2 diabetes. Studies with techniques not clearly described were excluded. Individual study quality was assessed using the criteria of Schulz and Jadad (randomisation procedure, allocation concealment, withdrawals, dropouts, intention to treat analysis, and masking of outcome assessors).Outcomes: changes in glycoted haemoglobin (HbAlc) and blood glucose concentrations. Secondary outcomes were changes in body weight and psychological distress.MAIN RESULTS25 studies met the selection criteria. Pooling of 12 RCTs showed lower HbA[lc] concentrations in patients who received a psychological intervention than in control group patients (table). Groups did not differ for changes in blood glucose concentration or body weight (table). 5 of 5 RCTs showed reductions in psychological distress with a psychological intervention (table).CONCLUSIONIn patients with type 2 diabetes mellitus, psychological interventions improve glycaemic control and reduce psychological distress.