Cognitive Behavioral Therapy for Depression Among Patients With Type 2 Diabetes

A scoping review found that cognitive behavioral therapy (CBT) generally had a positive impact on everyday life for patients with type 2 diabetes (T2D). These findings were published in the Journal of Diabetes and Its Complications.

Previous studies have found that depression is twice as prevalent among patients with diabetes compared with the general population. This prevalence may indicate that patients with T2D have an unmet psychiatric need. A team of investigators from Spain and Greece therefore searched publication databases for studies of CBT in the T2D setting in order to understand whether CBT may be an effective treatment for anxiety and depression experienced by patients with T2D.

A total of 11 randomized clinical trials comprising between 40 and 214 participants with T2D and co-occurring depression or diabetes-related distress were reviewed.

The CBT interventions were typically administered weekly by psychologists or specialized nurses and dietitians. All studies evaluated outcomes using validated instruments.

Most studies found that the CBT intervention had a significant effect on depressive symptoms. The longest-lasting improvements were reported by a study that included a psychoeducational component with the CBT intervention. This study observed that effects of the intervention were maintained at 12-month follow-up. Other studies that did not include a psychoeducational component in general reported significant reductions in depressive symptoms after the intervention; however, the effects waned by the 6-month or 12-month follow-up assessments.

No effect of the CBT intervention was reported by 3 studies.

In addition to reducing depressive symptoms, 3 studies found reductions in anxiety and 1 of these studies also reported reduced anger expression following the CBT intervention.

Stratified by gender, men were found to experience improvements in diabetes symptom distress after receiving CBT in 1 study, and women experienced reduced anxiety and anger expression following CBT with a psychoeducational component.

Among the 11 studies that evaluated glycemic control, 7 reported improved glycemic control; these improvements were found to correlate with adherence.

This review was limited by the high amount of heterogeneity among the underlying studies, and 2 of the included publications were found to be at high risk for bias.

The study authors concluded, “Our results further demonstrate that CBT-based interventions are effective for depressive symptoms and distress in patients with T2DM. […] The current results suggest that there is a need to adopt technical components of CBT that include cognitive and behavioral components to improve clinical outcomes and psychological well-being in patients with diabetes and that these may benefit from combinations of CBT-based interventions with other psychoeducational strategies.”

Reference

Vlachou E, Ntikoudi A, Owens DA, Nikolakopoulou M, Chalimourdas T, Cauli O. Effectiveness of cognitive behavioral therapy-based interventions on psychological symptoms in adults with type 2 diabetes mellitus: an update review of randomized controlled trials. J Diabetes Complications. Published online March 26, 2022. doi:10.1016/j.jdiacomp.2022.108185