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Fanelli G, Raschi E, Hafez G, Matura S, Schiweck C, Poluzzi E, Lunghi C. The interface of depression and diabetes: treatment considerations. Transl Psychiatry 2025; 15:22. [PMID: 39856085 PMCID: PMC11760355 DOI: 10.1038/s41398-025-03234-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2024] [Revised: 12/11/2024] [Accepted: 01/10/2025] [Indexed: 01/27/2025] Open
Abstract
This state-of-the-art review explores the relationship between depression and diabetes, highlighting the two-way influences that make treatment challenging and worsen the outcomes of both conditions. Depression and diabetes often co-occur and share genetic, lifestyle, and psychosocial risk factors. Lifestyle elements such as diet, physical activity, and sleep patterns play a role on the development and management of both conditions, highlighting the need for integrated treatment strategies. The evidence suggests that traditional management strategies focusing on either condition in isolation fall short of addressing the intertwined nature of diabetes and depression. Instead, integrated care models encompassing psychological support and medical management are recommended to improve treatment efficacy and patient adherence. Such models require collaboration across multiple healthcare disciplines, including endocrinology, psychiatry, and primary care, to offer a holistic approach to patient care. This review also identifies significant patient-related barriers to effective management, such as stigma, psychological resistance, and health literacy, which need to be addressed through patient-centered education and support systems. Future directions for research include longitudinal studies in diverse populations to further elucidate causal relationships and the exploration of novel therapeutic targets, as well as the effectiveness of healthcare models aimed at preventing the onset of one condition in individuals diagnosed with the other.
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Affiliation(s)
- Giuseppe Fanelli
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
- Department of Human Genetics, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behavior, Nijmegen, The Netherlands
| | - Emanuel Raschi
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Gaye Hafez
- Department of Pharmacology, Faculty of Pharmacy, Altinbas University, Istanbul, Turkey
| | - Silke Matura
- Institute of General Practice, Goethe University Frankfurt, Frankfurt am Main, Germany
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Carmen Schiweck
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Elisabetta Poluzzi
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Carlotta Lunghi
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.
- Population Health and Optimal Health Practices Research Group, CHU de Québec-Université Laval Research Center, Quebec City, QC, Canada.
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Tully PJ, Schutte N, Guppy MP, Garatva P, Wittert G, Baumeister H. Psychological interventions for depression in people with diabetes mellitus. Cochrane Database Syst Rev 2025; 1:CD016005. [PMID: 39775486 PMCID: PMC11707823 DOI: 10.1002/14651858.cd016005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2025]
Abstract
OBJECTIVES This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To determine the effects of psychological interventions for depression in people with diabetes mellitus.
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Affiliation(s)
- Phillip J Tully
- School of Psychology, Deakin University, Burwood, Australia
- School of Medicine, The University of Adelaide, Adelaide, Australia
- School of Psychology, University of New England, Armidale, Australia
| | - Nicola Schutte
- School of Psychology, University of New England, Armidale, Australia
| | - Michelle Pb Guppy
- School of Rural Medicine, University of New England, Armidale, Australia
| | - Patricia Garatva
- Department of Clinical Psychology and Psychotherapy, University of Ulm, Ulm, Germany
| | - Gary Wittert
- School of Medicine, The University of Adelaide, Adelaide, Australia
| | - Harald Baumeister
- Department of Clinical Psychology and Psychotherapy, University of Ulm, Ulm, Germany
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Manikappa SK, Shetty KV, Ashalatha K, Bamney U, Sachetha GM. Tele-counseling services for COVID-19 patients: Experiences from a state mental health institute in South India. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2024; 13:505. [PMID: 39850298 PMCID: PMC11756696 DOI: 10.4103/jehp.jehp_292_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 04/12/2023] [Indexed: 01/25/2025]
Abstract
BACKGROUND The COVID-19 pandemic has had profound implications for individuals' physical and mental health (MH), as well as well-being of populations worldwide. Several underlying issues which have a significant impact on MH, such as stress, worry, frustration, and uncertainty, were widespread during the COVID-19 pandemic. One of the common measures resorted to was to provide MH services to the population using information technology. This study shares the experience of tele-counseling services for patients with COVID-19 living in the hospital and in-home isolation during the pandemic phase of COVID-19 in the Dharwad district of Karnataka, a southern state in India. MATERIALS AND METHODS A mixed approach was used, which included 300 participants affected by COVID-19 and 3 case studies. The information was collected using a structured interviewer-administered questionnaire and case study methods. RESULT The mean age of the COVID patients was 40.72 ± 14.61 years. More than half of the COVID patients (51%) received treatment at hospital. Seventy-nine percent of callers received only single counseling session. The main tele-counseling services provided included supportive counseling (44%), sleep hygienic techniques (9%), general information on COVID (15%), problem-solving techniques (1.3%), relaxation techniques (5.7%), mindful mediation (2%), grief counseling (3.3%), family counseling (1.7%), and stress management (2.7%). CONCLUSION Tele-counseling services during an emergency like the COVID-19 pandemic can help in promoting MH and well-being of people affected by the pandemic. It is possible to provide such psychological first aid using information technology.
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Affiliation(s)
| | - Kannappa V. Shetty
- School of Social Work, Indira Gandhi National Open University (IGNOU), New Delhi, India
| | - K Ashalatha
- Department of Psychiatry, SDM University, Dharwad, Karnataka, India
| | - Urmila Bamney
- Department of Psychosocial Support in Disaster Management, NIMHANS, Bengaluru, India
| | - GM Sachetha
- Independent Mental Health Counsellor, Delhi, India
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Liu Z, Sang X, Liu Y, Yu C, Wan H. Effect of psychological intervention on glycemic control in middle-aged and elderly patients with type 2 diabetes mellitus: A systematic review and meta-analysis. Prim Care Diabetes 2024; 18:574-581. [PMID: 39322480 DOI: 10.1016/j.pcd.2024.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 09/08/2024] [Accepted: 09/15/2024] [Indexed: 09/27/2024]
Abstract
AIM There is an ongoing debate regarding the influence of psychological interventions on glycemic control in middle-aged and elderly patients diagnosed with type 2 diabetes. To establish evidence-based medical support for the therapeutic application of these interventions, this meta-analysis seeks to assess the impact of psychological interventions on glycemic control in middle-aged and elderly individuals with type 2 diabetes. METHODS This study systematically searched six electronic databases for randomized controlled studies of psychological interventions applied to middle-aged and elderly patients with type 2 diabetes, and the search time frames were all from the time of database creation to the search period from the establishment to March 2023. Two evaluators independently screened the literature evaluated the included studies' risk of bias, and carried out a meta-analysis using the RevMan5.4 program. RESULTS A total of 7 studies with 728 participants complied with the eligibility criteria. Meta-analysis showed that glycated glucagon was reduced in the psychological intervention group compared to the control group (MD = -0.26, 95 %CI:-0.51,-0.01,p = 0.01) with a statistically significant difference (p < 0.05). and their sensitivity analyses all showed stable and credible results. CONCLUSIONS This review concludes that psychological interventions, when applied to middle-aged and elderly individuals with type 2 diabetes, proved to be more effective in reducing HbA1c levels compared to standard care. Nevertheless, further evidence-based research is essential to elucidate the specific types of psychological interventions that contribute to improved glycemic control outcomes in middle-aged and older adults with type 2 diabetes.
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Affiliation(s)
- Zhiqun Liu
- Department of Emergency Medicine, Clinical Research Center For Emergency and Critical Care In Hunan Province, Hunan Provincial Institute of Emergency Medicine, Hunan Provincial Key Laboratory of Emergency and Critical Care Metabonomics, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha 410005, China
| | - Xiaohan Sang
- Department of Nursing, Hunan Normal University School of Medicine, Changsha 410013, China
| | - Yanhui Liu
- Changsha Medical University, Changsha, 410219, China
| | - Chuochuo Yu
- Department of Nursing, Hunan Normal University School of Medicine, Changsha 410013, China
| | - Huan Wan
- Department of Nursing, The First Hospital Affiliated with Hunan Normal University (Hunan Provincial People's Hospital), Changsha 410005, China.
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Alnajjar AZ, Abouelmagd ME, Krayim A, AbdelMeseh M, Bushara N, Nabil Y. Efficacy of cognitive behavioral therapy for anxiety and depression in Parkinson's disease patients: an updated systematic review and meta-analysis. Neurol Sci 2024; 45:5277-5290. [PMID: 38958793 PMCID: PMC11470855 DOI: 10.1007/s10072-024-07659-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Accepted: 06/14/2024] [Indexed: 07/04/2024]
Abstract
BACKGROUND Parkinson's disease (PD) patients often experience non-motor symptoms like depression and anxiety, significantly impacting their quality of life. With the limited effectiveness of pharmacological treatments, effective non-pharmacological interventions are needed. This systematic review and meta-analysis aimed to evaluate the efficacy of cognitive-behavioral therapy (CBT) in reducing depression and anxiety symptoms in PD patients. METHODS Randomized controlled trials (RCTs) exploring CBT's effectiveness for depression and anxiety in PD patients were included. Studies published until April 2023 were identified from PubMed, Web of Science, and Scopus. Methodological quality was assessed using the Risk of Bias-2 (ROB-2) tool. Statistical analysis involved calculating the standardized mean difference (SMD) and corresponding 95% confidence intervals (CIs) using Review Manager 5.4.1. RESULTS The systematic review included 12 studies involving 241 PD patients. CBT led to a substantial reduction in anxiety (SMD -0.95, 95% CI [-1.15 to -0.74], P < 0.00001) and depression (SMD -1.02, 95% CI [-1.39 to -0.65], P < 0.0001). Both traditional CBT and tele-CBT (administered over the phone or internet) were effective in treating depression and anxiety. Traditional CBT improved depression (SMD -1.16, 95% CI [-1.83 to -0.49], P < 0.00001), while tele-CBT showed comparable results (SMD -0.90, 95% CI [-1.31 to -0.48], P < 0.00001). For anxiety, both traditional CBT (SMD -0.94, 95% CI [-1.25 to -0.63], P < 0.00001) and tele-CBT (SMD -0.95, 95% CI [-1.22 to -0.67], P < 0.00001) significantly reduced symptoms. In conclusion, this systematic review and meta-analysis demonstrated the efficacy of CBT in reducing depression and anxiety in PD patients. Healthcare providers are encouraged to integrate CBT into their treatment protocols. However, additional high-quality studies with longer-term follow-up assessments are needed to further enhance understanding in this area. PROSPERO REGISTRATION CRD42023424758.
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Affiliation(s)
| | | | | | | | | | - Yehia Nabil
- Faculty of Medicine, Zagazig University, Zagazig, Egypt
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de Frel DL, Schroijen MA, Aardoom JJ, van Gils W, Huisman SD, Janssen VR, Versluis A, Kleinsmann MS, Atsma DE, Pijl H. Participatory Development of an Integrated, eHealth-Supported, Educational Care Pathway (Diabetes Box) for People With Type 2 Diabetes: Development and Usability Study. JMIR Hum Factors 2024; 11:e45055. [PMID: 38819880 PMCID: PMC11179029 DOI: 10.2196/45055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 09/17/2023] [Accepted: 11/20/2023] [Indexed: 06/01/2024] Open
Abstract
BACKGROUND Type 2 diabetes (T2D) tremendously affects patient health and health care globally. Changing lifestyle behaviors can help curb the burden of T2D. However, health behavior change is a complex interplay of medical, behavioral, and psychological factors. Personalized lifestyle advice and promotion of self-management can help patients change their health behavior and improve glucose regulation. Digital tools are effective in areas of self-management and have great potential to support patient self-management due to low costs, 24/7 availability, and the option of dynamic automated feedback. To develop successful eHealth solutions, it is important to include stakeholders throughout the development and use a structured approach to guide the development team in planning, coordinating, and executing the development process. OBJECTIVE The aim of this study is to develop an integrated, eHealth-supported, educational care pathway for patients with T2D. METHODS The educational care pathway was developed using the first 3 phases of the Center for eHealth and Wellbeing Research roadmap: the contextual inquiry, the value specification, and the design phase. Following this roadmap, we used a scoping review about diabetes self-management education and eHealth, past experiences of eHealth practices in our hospital, focus groups with health care professionals (HCPs), and a patient panel to develop a prototype of an educational care pathway. This care pathway is called the Diabetes Box (Leiden University Medical Center) and consists of personalized education, digital educational material, self-measurements of glucose, blood pressure, activity, and sleep, and a smartphone app to bring it all together. RESULTS The scoping review highlights the importance of self-management education and the potential of telemonitoring and mobile apps for blood glucose regulation in patients with T2D. Focus groups with HCPs revealed the importance of including all relevant lifestyle factors, using a tailored approach, and using digital consultations. The contextual inquiry led to a set of values that stakeholders found important to include in the educational care pathway. All values were specified in biweekly meetings with key stakeholders, and a prototype was designed. This prototype was evaluated in a patient panel that revealed an overall positive impression of the care pathway but stressed that the number of apps should be restricted to one, that there should be no delay in glucose value visualization, and that insulin use should be incorporated into the app. Both patients and HCPs stressed the importance of direct automated feedback in the Diabetes Box. CONCLUSIONS After developing the Diabetes Box prototype using the Center for eHealth and Wellbeing Research roadmap, all stakeholders believe that the concept of the Diabetes Box is useful and feasible and that direct automated feedback and education on stress and sleep are essential. A pilot study is planned to assess feasibility, acceptability, and usefulness in more detail.
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Affiliation(s)
| | - Mariëlle A Schroijen
- Division of Endocrinology, Department of Internal Medicine, Leiden University Medical Center, Leiden, Netherlands
| | - Jiska J Aardoom
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
- National eHealth Living Lab, Leiden, Netherlands
| | - Wesley van Gils
- Division of Endocrinology, Department of Internal Medicine, Leiden University Medical Center, Leiden, Netherlands
| | - Sasja D Huisman
- Division of Endocrinology, Department of Internal Medicine, Leiden University Medical Center, Leiden, Netherlands
| | - Veronica R Janssen
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Anke Versluis
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
- National eHealth Living Lab, Leiden, Netherlands
| | - Maaike S Kleinsmann
- Department of Design, Organization and Strategy, Faculty of Industrial Design Engineering, Delft University of Technology, Delft, Netherlands
| | - Douwe E Atsma
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
- National eHealth Living Lab, Leiden, Netherlands
- Department of Design, Organization and Strategy, Faculty of Industrial Design Engineering, Delft University of Technology, Delft, Netherlands
| | - Hanno Pijl
- Division of Endocrinology, Department of Internal Medicine, Leiden University Medical Center, Leiden, Netherlands
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
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Snoek FJ, Anarte-Ortiz MT, Anderbro T, Cyranka K, Hendrieckx C, Hermanns N, Indelicato L, McGuire BE, Mocan A, Nefs G, Polonsky WH, Stewart R, Vallis M. Roles and competencies of the clinical psychologist in adult diabetes care-A consensus report. Diabet Med 2024; 41:e15312. [PMID: 38385984 DOI: 10.1111/dme.15312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 01/29/2024] [Accepted: 02/06/2024] [Indexed: 02/23/2024]
Abstract
AIMS Psychological care is recognised as an integral part of quality diabetes care. We set out to describe the roles and competencies of the clinical psychologist as a member of the multidisciplinary adult diabetes care team, focused on secondary care. METHODS The authors are clinically experienced psychologists involved in adult diabetes care, from Australia, Europe and North America, and active members of the international psychosocial aspects of diabetes study group. Consensus was reached as a group on the roles and competencies of the clinical psychologist working in adult diabetes secondary care, building both on expert opinion and a selective review and discussion of the literature on psychological care in diabetes, clinical guidelines and competency frameworks. RESULTS The clinical psychologist fulfils multiple roles: (1) as a clinician (psychological assessment and therapy), (2) as advisor to the healthcare team (training, consulting), (3) as a communicator and promotor of person-centred care initiatives and (4) as a researcher. Four competencies that are key to successfully fulfilling the above-mentioned roles in a diabetes setting are as follows: (a) specialised knowledge, (b) teamwork and advice, (c) assessment, (d) psychotherapy (referred to as STAP framework). CONCLUSIONS The roles and competencies of clinical psychologists working in diabetes extend beyond the requirements of most university and post-graduate curricula. There is a need for a comprehensive, accredited specialist post-graduate training for clinical psychologists working in diabetes care, building on the proposed STAP framework. This calls for a collaborative effort involving diabetes organisations, clinical psychology societies and diabetes psychology interest groups.
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Affiliation(s)
- Frank J Snoek
- Department of Medical Psychology, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam UMC, Amsterdam, The Netherlands
| | - Maria Teresa Anarte-Ortiz
- Departamento de Personalidad, Evaluación y Tratamiento Psicológico, Facultad de Psicología, Universidad de Málaga, Málaga, Spain
- Departamento de Personalidad, Evaluacion y Tratamiento Psicologico, Instituto de Investigación Biomedica de Málaga (IBIMA), Málaga, Spain
| | - Therese Anderbro
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Katarzyna Cyranka
- Department of Psychiatry, Jagiellonian University Medical College, Krakow, Poland
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland
| | - Christel Hendrieckx
- The Australian Centre for Behavioural Research in Diabetes, Carlton, Victoria, Australia
- School of Psychology, Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
| | - Norbert Hermanns
- Forschungsinstitut Diabetes-Akademie Bad Mergentheim (FIDAM GmbH), Bad Mergentheim, Germany
- Department of Clinical Psychology, Psychotherapy of the University of Bamberg, Bamberg, Germany
| | - Liliana Indelicato
- Divission od Endocrinology, Diabetes and Metabolic Diseases, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Brian E McGuire
- School of Psychology, University of Galway and Centre for Diabetes, Endocrinology & Metabolism, Galway University Hospital, Galway, Ireland
| | - Andreia Mocan
- Center for Diabetes, Nutrition and Metabolic Diseases, Emergency Clinical County Hospital, Cluj-Napoca, Romania
| | - Giesje Nefs
- Department of Medical Psychology, Radboud UMC, Nijmegen, The Netherlands
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
- Diabeter, National Treatment and Research Center for Children, Adolescents and Adults with Type 1 Diabetes, Rotterdam, The Netherlands
| | - William H Polonsky
- Behavioral Diabetes Institute, San Diego, California, USA
- Department of Medicine, University of California, San Diego, California, USA
| | - Rose Stewart
- Betsi Cadwaladr University Health Board, Hospitals and Health Care, North Wales, UK
| | - Michael Vallis
- Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
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Nong Y, Wu G, Lu J, Wei X, Yu D. The mediating role of obesity in the development of depression in individuals with diabetes: A population-based study from NHANES 2005-2014. J Affect Disord 2024; 351:977-982. [PMID: 38355056 DOI: 10.1016/j.jad.2024.02.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 01/27/2024] [Accepted: 02/11/2024] [Indexed: 02/16/2024]
Abstract
OBJECTIVE Depression is one of the common manifestations of diabetes population, and previous studies have shown that there is a correlation between depression and diabetes. This study was conducted retrospectively through the large National Health and Nutrition Examination Survey (NHANES) to explore the risk of depression in different individuals with diabetes. METHODS We collected data on a total of 33,001 individuals in 5 cycles of NHANES and compared the incidence of depression in the individuals with diabetes, pre-diabetes or without diabetes groups after weighting. A weighted logistic review was used to assess the association between diabetes and depression at different BMI, sex, and age levels. Mediating analysis was used to assess the risk of depression in people with obesity-mediated diabetes. In addition, the non-linear relationship between BMI and depression at different factor levels was evaluated using restricted cubic strips (RCS). RESULTS Diabetes was significantly associated with depression in obesity, especially for female (OR: 1.45, 95 % CI: 1.20-1.75, P < 0.001) and young ( CONCLUSIONS There is a significant correlation between diabetes and depression, and obesity as a mediating variable mediates the correlation between diabetes and depression. Especially in obese, young (age < 60) and women, the phenomenon is more pronounced.
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Affiliation(s)
- Yuxin Nong
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 510080 Guangzhou, China
| | - Guangyu Wu
- Department of Neurology, Guangzhou Key Laboratory of Diagnosis and Treatment for Neurodegenerative Diseases, Guangdong Neuroscience Institute, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 510080 Guangzhou, China
| | - Junquan Lu
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 510080 Guangzhou, China
| | - Xuebiao Wei
- Department of Geriatric Intensive Medicine, Guangdong Provincial Geriatrics Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 51080 Guangzhou, China.
| | - Danqing Yu
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 510080 Guangzhou, China.
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Henson J, Covenant A, Hall AP, Herring L, Rowlands AV, Yates T, Davies MJ. Waking Up to the Importance of Sleep in Type 2 Diabetes Management: A Narrative Review. Diabetes Care 2024; 47:331-343. [PMID: 38394635 DOI: 10.2337/dci23-0037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 09/27/2023] [Indexed: 02/25/2024]
Abstract
For the first time, the latest American Diabetes Association/European Association for the Study of Diabetes (ADA/EASD) consensus guidelines have incorporated a growing body of evidence linking health outcomes associated with type 2 diabetes to the movement behavior composition over the whole 24-h day. Of particular note, the importance of sleep as a key lifestyle component in the management of type 2 diabetes is promulgated and presented using three key constructs: quantity, quality, and timing (i.e., chronotype). In this narrative review we highlight some of the key evidence justifying the inclusion of sleep in the latest consensus guidelines by examining the associations of quantity, quality, and timing of sleep with measures of glycemia, cardiovascular disease risk, and mortality. We also consider potential mechanisms implicated in the association between sleep and type 2 diabetes and provide practical advice for health care professionals about initiating conversations pertaining to sleep in clinical care. In particular, we emphasize the importance of measuring sleep in a free-living environment and provide a summary of the different methodologies and targets. In summary, although the latest ADA/EASD consensus report highlights sleep as a central component in the management of type 2 diabetes, placing it, for the first time, on a level playing field with other lifestyle behaviors (e.g., physical activity and diet), the evidence base for improving sleep (beyond sleep disorders) in those living with type 2 diabetes is limited. This review should act as a timely reminder to incorporate sleep into clinical consultations, ongoing diabetes education, and future interventions.
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Affiliation(s)
- Joseph Henson
- NIHR Leicester Biomedical Research Centre, Diabetes Research Centre, College of Life Sciences, University of Leicester, U.K
| | - Alix Covenant
- NIHR Leicester Biomedical Research Centre, Diabetes Research Centre, College of Life Sciences, University of Leicester, U.K
| | - Andrew P Hall
- University Hospitals of Leicester NHS Trust, Leicester, U.K
- Hanning Sleep Laboratory, Leicester General Hospital, Leicester, U.K
| | - Louisa Herring
- NIHR Leicester Biomedical Research Centre, Diabetes Research Centre, College of Life Sciences, University of Leicester, U.K
- University Hospitals of Leicester NHS Trust, Leicester, U.K
| | - Alex V Rowlands
- NIHR Leicester Biomedical Research Centre, Diabetes Research Centre, College of Life Sciences, University of Leicester, U.K
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), UniSA Allied Health and Human Performance, University of South Australia, Adelaide, Australia
| | - Thomas Yates
- NIHR Leicester Biomedical Research Centre, Diabetes Research Centre, College of Life Sciences, University of Leicester, U.K
| | - Melanie J Davies
- NIHR Leicester Biomedical Research Centre, Diabetes Research Centre, College of Life Sciences, University of Leicester, U.K
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10
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Jiang S, Pan X, Li H, Su Y. Global trends and developments in mindfulness interventions for diabetes: a bibliometric study. Diabetol Metab Syndr 2024; 16:43. [PMID: 38360701 PMCID: PMC10870632 DOI: 10.1186/s13098-024-01288-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 02/08/2024] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND Diabetes is a metabolic disorder posing a global threat to health. Many scholars are dedicated to developing non-pharmacological therapies, and mindfulness intervention is among the potentially effective approaches. Due to the rapid increase in relevant research in recent years, along with the diverse focus and interventions used in studies, it has become challenging for practitioners to quickly comprehend the key features of this field and the directions worth paying attention to. Bibliometric analysis, in response, can help scholars understand this field and identify points of interest. METHODS Publications related to mindfulness intervention in diabetes from the establishment of the Web of Science Core Collection (WOSCC) to September 2023 were searched. We employed four bibliometric techniques: General Analysis of Publications, Collaborative Network Analysis, Co-citation Analysis, and Keyword Analysis. The CiteSpace 6.1.R was used to analyze the literature with the strongest citation bursts, while VOSviewer 1.6.13 was used to provide visualizations of publicly available data by analyzing co-citations or co-authorship affiliations. RESULTS We found a total of 387 articles. The results indicate that research on this topic has been steadily increasing over time. The United States is the top producer of relevant publications, with Tilburg University being the institution that publishes the most articles. The journal "Mindfulness" has the highest publication count. In the collaborative network analysis, the United States emerged as the main hub for global cooperation in this research field, contributing 182 articles with a total of 5872 citations. The journal "Diabetes Care" was frequently cited and played a central role. The keyword analysis revealed that researchers have shown a strong interest in how mindfulness interventions affect the mental health of diabetic individuals. Additionally, there is a focus on studying elderly diabetic groups and exploring how mindfulness interventions impact metabolic diseases. These areas are currently the main research priorities. CONCLUSION Our findings demonstrate the current trend and hotspots in mindfulness intervention and offer some directions for future research.
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Affiliation(s)
- Sijia Jiang
- College of Physical Education, Chongqing University of Posts and Telecommunications, Chongqing, China
| | - Xiaoli Pan
- Institute of Sport Science, College of Physical Education, Southwest University, Chongqing, China
| | - Hansen Li
- Institute of Sport Science, College of Physical Education, Southwest University, Chongqing, China
| | - Yuqin Su
- Institute of Sport Science, College of Physical Education, Southwest University, Chongqing, China.
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11
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Yap JM, Tantono N, Wu VX, Klainin-Yobas P. Effectiveness of technology-based psychosocial interventions on diabetes distress and health-relevant outcomes among type 2 diabetes mellitus: A systematic review and meta-analysis. J Telemed Telecare 2024; 30:262-284. [PMID: 34825839 DOI: 10.1177/1357633x211058329] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Poor management of type 2 diabetes mellitus may affect individuals' physical and emotional health. Access to ongoing psychosocial interventions through technological platforms may potentially minimise diabetes complications and improve health-related outcomes. However, little is known about the effectiveness of such interventions on diabetes distress and health-related outcomes. OBJECTIVE To synthesise the best available evidence concerning the effectiveness of technology-based psychosocial interventions on diabetes distress, self-efficacy, health-related quality of life, and HbA1c level in adults with type 2 diabetes mellitus. METHODS A search of eleven databases was conducted to identify randomised controlled trials that examined the effects of technology-based psychosocial interventions on the outcomes. Randomised controlled trials reported in English from 2010 to 2020 were included. Selection of studies, quality appraisal, and data extraction were conducted by two reviewers independently. Meta-analyses, subgroup analyses and sensitivity analysis were performed using Review Manager. Intervention effects was measured using standardise mean difference. RESULTS Twenty randomised controlled trials fulfilled the eligibility criteria and 18 randomised controlled trials were included in meta-analysis. technology-based psychosocial interventions improved diabetes distress, self-efficacy and HbA1c levels with significant and small effect sizes. Subgroup analyses revealed greater improvement in health-related quality of life for participants with comorbid depression and lower HbA1c levels for studies with lesser than 100 participants. CONCLUSION The findings of this review increase knowledge on the effectiveness of technology-based psychosocial interventions on diabetes distress and self-efficacy. However, evidence to support the effects of technology-based psychosocial interventions on HbA1c and health-related quality of life was not strong. More research is needed to examine the effectiveness of the psychosocial interventions delivered through mobile applications or virtual reality.
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Affiliation(s)
| | | | - Vivien Xi Wu
- Alice Lee Centre for Nursing Studies, National University of Singapore, Singapore
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12
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Sherifali D, Whitmore C, Naeem F, Melamed OC, Dragonetti R, Kouzoukas E, Marttila J, Tang F, Tanzini E, Ramdass S, Selby P. Technology-Enabled Collaborative Care for Type-2 Diabetes and Mental Health (TECC-D): Findings From a Mixed Methods Feasibility Trial of a Responsive Co-Designed Virtual Health Coaching Intervention. Int J Integr Care 2024; 24:12. [PMID: 38370569 PMCID: PMC10870944 DOI: 10.5334/ijic.7608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 02/08/2024] [Indexed: 02/20/2024] Open
Abstract
Introduction Type-2 diabetes (T2D) is a complex chronic condition associated with a lower quality of life due to disease specific distress. While there is growing support for personalized diabetes programs, care for mental health challenges is often fragmented and limited by access to psychiatry, and integration of care. The use of communication technology to improve team based collaborative care to bridge these gaps is promising but untested. Methods We conducted an explanatory sequential mixed methods study to assess the feasibility and acceptability of the co-designed Technology-Enabled Collaborative Care for Diabetes and Mental Health (TECC-D) program. Participants included adults aged ≥18 years who had a clinical diagnosis of T2D, and self-reported mental health concerns. Results 31 participants completed the 8-week virtual TECC-D program. Findings indicate that the program is feasible and acceptable and indicate that there is a role for virtual diabetes and mental health care. Discussion The TECC-D program, designed through an iterative co-design process and supported by innovative, responsive adaptations led to good uptake and satisfaction. Conclusion The TECC-D model is a feasible and scalable care solution that empowers individuals living with T2D and mental health concerns to take an active role in their care.
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Affiliation(s)
- Diana Sherifali
- School of Nursing, McMaster University, Hamilton ON Canada
- Population Health Research Institute, Hamilton ON Canada
- Nicotine Dependence Service, Centre for Addiction and Mental Health, Toronto ON Canada
| | - Carly Whitmore
- School of Nursing, McMaster University, Hamilton ON Canada
- Nicotine Dependence Service, Centre for Addiction and Mental Health, Toronto ON Canada
| | - Farooq Naeem
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto ON Canada
| | - Osnat C. Melamed
- Nicotine Dependence Service, Centre for Addiction and Mental Health, Toronto ON Canada
- Department of Family and Community Medicine, University of Toronto, Toronto ON Canada
| | - Rosa Dragonetti
- Nicotine Dependence Service, Centre for Addiction and Mental Health, Toronto ON Canada
- Department of Family and Community Medicine, University of Toronto, Toronto ON Canada
| | - Erika Kouzoukas
- Nicotine Dependence Service, Centre for Addiction and Mental Health, Toronto ON Canada
| | | | - Frank Tang
- Diabetes Action Canada, Toronto ON Canada
| | - Elise Tanzini
- Nicotine Dependence Service, Centre for Addiction and Mental Health, Toronto ON Canada
| | - Seeta Ramdass
- Diabetes Action Canada, Toronto ON Canada
- Office of Social Accountability and Community Engagement, McGill University, Montreal QC Canada
| | - Peter Selby
- Nicotine Dependence Service, Centre for Addiction and Mental Health, Toronto ON Canada
- Department of Family and Community Medicine, University of Toronto, Toronto ON Canada
- Department of Psychiatry, University of Toronto, Toronto ON Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto ON Canada
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13
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Tripathi P, Kathrikolly TR. Lifestyle Intervention for Diabetes Remission: A Paradigm Shift inDiabetes Care and Management. Curr Diabetes Rev 2024; 20:e291123224009. [PMID: 38093443 DOI: 10.2174/0115733998272795231109034141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 10/11/2023] [Accepted: 10/18/2023] [Indexed: 08/06/2024]
Abstract
Remission is often considered the ultimate goal in T2D management and care. Although metabolic surgery is the conventional choice to achieve remission, substantial evidence suggests the possibility of T2D remission through lifestyle interventions. In this context, the current perspective explores recent scientific advancements in lifestyle intervention for diabetes remission and also emphasises its clinical applicability as a pragmatic approach to diabetes management. The perspective further provides additional evidence on remission from the authors' own research findings in the Indian population. We propose that a holistic lifestyle intervention approach - individualised diet plan, exercise protocol, and psychological intervention - may be a benchmark protocol to achieve T2D remission.
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Affiliation(s)
- Pramod Tripathi
- Department of Research, Freedom from Diabetes Research Foundation, Pune, Maharashtra, India
| | - Thejas R Kathrikolly
- Department of Research, Freedom from Diabetes Research Foundation, Pune, Maharashtra, India
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14
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Priyadarshini A, Madan R, Das S. Genetics and epigenetics of diabetes and its complications in India. Hum Genet 2024; 143:1-17. [PMID: 37999799 DOI: 10.1007/s00439-023-02616-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 10/17/2023] [Indexed: 11/25/2023]
Abstract
Diabetes mellitus (DM) has become a significant health concern with an increasing rate of morbidity and mortality worldwide. India ranks second in the number of diabetes cases in the world. The increasing burden of DM can be explained by genetic predisposition of Indians to type 2 diabetes mellitus (T2DM) coupled with rapid urbanization and socio-economic development in the last 3 decades leading to drastic changes in lifestyle. Environment and lifestyle changes contribute to T2DM development by altering epigenetic processes such as DNA methylation, histone post-translational modifications, and long non-coding RNAs, all of which regulate chromatin structure and gene expression. Although the genetic predisposition of Indians to T2DM is well established, how environmental and genetic factors interact and lead to T2DM is not well understood. In this review, we discuss the prevalence of diabetes and its complications across different states in India and how various risk factors contribute to its pathogenesis. The review also highlights the role of genetic predisposition among the Indian population and epigenetic factors involved in the etiology of diabetes. Lastly, we review current treatments and emphasize the knowledge gap with respect to genetic and epigenetic factors in the Indian context. Further understanding of the genetic and epigenetic determinants will help in risk prediction and prevention as well as therapeutic interventions, which will improve the clinical management of diabetes and associated macro- and micro-vascular complications.
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Affiliation(s)
- Ankita Priyadarshini
- Diabetic Vascular Complications Laboratory, Department of Biological Sciences, Indian Institute of Science Education and Research (IISER) Mohali, Mohali, Punjab, 140306, India
| | - Riya Madan
- Diabetic Vascular Complications Laboratory, Department of Biological Sciences, Indian Institute of Science Education and Research (IISER) Mohali, Mohali, Punjab, 140306, India
| | - Sadhan Das
- Diabetic Vascular Complications Laboratory, Department of Biological Sciences, Indian Institute of Science Education and Research (IISER) Mohali, Mohali, Punjab, 140306, India.
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15
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Wijk I, Amsberg S, Johansson UB, Livheim F, Toft E, Anderbro T. Impact of an Acceptance and Commitment Therapy programme on HbA1c, self-management and psychosocial factors in adults with type 1 diabetes and elevated HbA1c levels: a randomised controlled trial. BMJ Open 2023; 13:e072061. [PMID: 38101850 PMCID: PMC10729111 DOI: 10.1136/bmjopen-2023-072061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 12/06/2023] [Indexed: 12/17/2023] Open
Abstract
OBJECTIVE To evaluate the impact of an Acceptance and Commitment Therapy (ACT) programme, tailored for people living with type 1 diabetes, on glycated haemoglobin (HbA1c), self-management and psychosocial factors among individuals with HbA1c>60 mmol/mol compared with treatment as usual (TAU). SETTING An endocrinologic clinic in Sweden. PARTICIPANTS In this randomised controlled trial, 81 individuals with type 1 diabetes, aged 18-70 years with HbA1c>60 mmol/mol, were randomly assigned to either an ACT group intervention or TAU. Exclusion criteria were: unable to speak Swedish, untreated or severe psychiatric disease, cortisone treatment, untreated thyroid disease and newly started insulin pump therapy. At the 2-year follow-up, HbA1c was measured in 26 individuals. INTERVENTION The ACT programme comprised seven 2-hour sessions held over 14 weeks and focused on acceptance of stressful thoughts and emotions, and to promote value-based committed action. OUTCOMES The primary outcome was HbA1c, and the secondary outcomes were measures of depression, anxiety, general stress, fear of hypoglycaemia, diabetes distress, self-care activities, psychological flexibility (general and related to diabetes) and quality of life. The primary endpoint was HbA1c 2 years after the intervention programme. Linear mixed models were used to test for an interaction effect between measurement time and group. RESULTS Likelihood ratio test of nested models demonstrated no statistically significant interaction effect (χ2=0.49, p=0.485) between measurement time and group regarding HbA1c. However, a statistically significant interaction effect (likelihood ratio test χ2=12.63, p<0.001) was observed with improved scores on The Acceptance and Action Questionnaire in the intervention group after 1 and 2 years. CONCLUSIONS No statistically significant difference was found between the groups regarding the primary outcome measure, HbA1c. However, the ACT programme showed a persistent beneficial impact on psychological flexibility in the intervention group. The dropout rate was higher than expected, which may indicate a challenge in this type of study. TRIAL REGISTRATION NUMBER NCT02914496.
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Affiliation(s)
- Ingrid Wijk
- Department of Health Promoting Science, Sophiahemmet University, Stockholm, Sweden
| | - Susanne Amsberg
- Department of Health Care Sciences, Marie Cederschiöld University, Stockholm, Sweden
| | - Unn-Britt Johansson
- Department of Health Promoting Science, Sophiahemmet University, Stockholm, Sweden
- Department of Clinical Sciences and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Fredrik Livheim
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Eva Toft
- Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
- Department of Medicine, Ersta Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Therese Anderbro
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
- Department of Psychology, Stockholm University, Stockholm, Sweden
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Carreira M, Ruiz de Adana MS, Pinzón JL, Anarte-Ortiz MT. Internet-based cognitive-behavioral therapy is effective in reducing depressive symptomatology in type 1 diabetes: results of a randomized controlled trial. FRONTIERS IN CLINICAL DIABETES AND HEALTHCARE 2023; 4:1209236. [PMID: 38028977 PMCID: PMC10661942 DOI: 10.3389/fcdhc.2023.1209236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 09/25/2023] [Indexed: 12/01/2023]
Abstract
Objective Depression in people with diabetes is associated with poorer health outcomes. Although web programs integrating cognitive-behavioral therapy with diabetes education have shown good results, no similar approach has been implemented in Spain. This aim of this study was to administer an Internet-based cognitive-behavioral therapy program (CBT) for the treatment of mild-moderate depressive symptomatology in individuals with type 1 diabetes (WEB_TDDI1 study) and evaluate the efficacy of this program. Research design and methods A pre-post randomized controlled study was conducted. The sample comprised 65 people with type 1 diabetes and mild-moderate depressive symptoms: 35 treatment group (TG) and 30 control group (CG). The following effects of the nine-session program were analyzed: depression (Beck Depression Inventory Fast Screen, BDI-FS), metabolic variables (glycosilated hemoglobin, HbA1c), and other psychological variables including anxiety (State Trait Anxiety Inventory, STAI), fear of hypoglycemia (Fear of Hypoglycemia Questionnaire, FH-15), distress (Diabetes Distress Questionnaire (DDS), quality of life (Diabetes Quality of Life Questionnaire, DQOL),and treatment adherence (Diabetes Self-Care Inventory-Revised questionnaire, SCI-R). Results At the end of the treatment program, only 28 people were evaluated (TG=8; CG=20). However, a significant reduction was found in both groups in BDI-FS and STAI-T scores, which was significantly greater in the TG. Significant improvements were also found in the TG in DQOL, FH-15, DDS and SCI-R scores. The percentage change in these variables was also statistically significant in the TG versus the CG. However, no significant results were found in HbA1c. Conclusions The Internet-based cognitive-behavioral therapy program for the treatment of mild-moderate depressive symptomatology in people with type 1 diabetes (WEB_TDDI1 study) is effective in reducing depressive symptomatology in the sample that completed the study. Positive results are also produced in other variables associated with depression in this population such as diabetes-related distress, trait anxiety, fear of hypoglycemia, quality of life, and adherence to diabetes treatment. Although new studies would be necessary to support the results of this platform, the results obtained are positive and support the use of this platform as an appropriate treatment for this population. Clinical trial registration ClinicalTrials.gov; identifier NCT03473704.
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Affiliation(s)
- Mónica Carreira
- Department of Personality, Assessment and Psychological Treatment, Instituto de Investigación Biomedica de Málaga (IBIMA), University of Malaga, Malaga, Spain
| | - Ma Soledad Ruiz de Adana
- Clinical Management Unit of Endocrinology and Nutrition, Instituto de Investigación Biomedica de Málaga (IBIMA), Regional University Hospital, University of Malaga, Malaga, Spain
| | - José Luis Pinzón
- Clinical Management Unit of Endocrinology and Nutrition, Instituto de Investigación Biomedica de Málaga (IBIMA), Virgen de la Victoria University Hospital, University of Malaga, Malaga, Spain
| | - María Teresa Anarte-Ortiz
- Department of Personality, Assessment and Psychological Treatment, Instituto de Investigación Biomedica de Málaga (IBIMA), University of Malaga, Malaga, Spain
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17
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Breland JY, Tseng CH, Toyama J, Washington DL. Influence of depression on racial and ethnic disparities in diabetes control. BMJ Open Diabetes Res Care 2023; 11:e003612. [PMID: 37989347 PMCID: PMC10660156 DOI: 10.1136/bmjdrc-2023-003612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 09/30/2023] [Indexed: 11/23/2023] Open
Abstract
INTRODUCTION We tested the hypotheses that depression diagnoses influence racial and ethnic disparities in diabetes control and that mental health treatment moderates that relationship. RESEARCH DESIGN AND METHODS We created a national cohort of Veterans Health Administration (VHA) patients with diabetes using administrative data (n=815 067). Cross-sectional linear mixed effects regression models tested the hypothesized indirect effect of depression on poor diabetes control (glycosylated hemoglobin >9%) and tested whether mental health treatment (visits or antidepressant prescriptions) moderated the effect of depression (α=0.05). Results represent the percentage point difference in probability of poor diabetes control. Covariates included primary care visits, sex, age, and VHA facility. RESULTS Overall, 20% of the cohort had poor diabetes control and 22% had depression. Depression was more common among racial and ethnic minoritized groups. The probability of poor diabetes control was higher for most minoritized groups compared with White patients (largest difference: American Indian or Alaska Native patients, 5.2% (95% CI 4.3%, 6.0%)). The absolute value of the proportion of racial and ethnic disparities accounted for by depression ranged from 0.2% (for Hispanic patients) to 2.0% (for Asian patients), with similar effects when accounting for the moderating effect of mental health treatment. Patients with depression and 5+ mental health visits had a lower probability of poor diabetes control compared with those with fewer visits, regardless of antidepressant prescription status. CONCLUSIONS The influence of depression on disparities in diabetes control was small. High rates of depression among people with diabetes, especially among those from racial and ethnic minoritized groups, highlight a need to ensure equitable and coordinated care for both conditions, as the effects of mental health treatment may extend to the control of physical health conditions.
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Affiliation(s)
- Jessica Y Breland
- VA HSR&D Center for Innovation to Implementation, Menlo Park Division (152), VA Palo Alto Health Care System, Palo Alto, California, USA
| | - Chi-Hong Tseng
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
- Department of Medicine, David Geffen School of Medicine, Los Angeles, California, USA
| | - Joy Toyama
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Donna L Washington
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
- Department of Medicine, David Geffen School of Medicine, Los Angeles, California, USA
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18
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Maimaitituerxun R, Chen W, Xiang J, Xie Y, Kaminga AC, Wu XY, Chen L, Yang J, Liu A, Dai W. Prevalence of Anxiety and Associated Factors Among Inpatients with Type 2 Diabetes Mellitus in China: A Cross-Sectional Study. Psychiatr Q 2023; 94:371-383. [PMID: 37389720 DOI: 10.1007/s11126-023-10040-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 06/15/2023] [Accepted: 06/15/2023] [Indexed: 07/01/2023]
Abstract
This study aimed to investigate the prevalence of anxiety and its associated factors among inpatients with type 2 diabetes mellitus (T2DM) in China. This study was a cross-sectional study. Inpatients with T2DM admitted to the Endocrinology Department of Xiangya Hospital, Central South University in Hunan Province of China from March 2021 to December 2021 were consecutively included in this study. Participants were interviewed to obtain the data on socio-demographic characteristics, lifestyle characteristics, T2DM-related information, and social support. Anxiety was measured using the Hospital Anxiety and Depression Scale-anxiety subscale by experienced physicians. Multivariable logistic regression analysis was used to estimate the independent contribution of each independent variable to anxiety. A total of 496 inpatients with T2DM were included in this study. The prevalence of anxiety was 21.8% (95% confidence interval [CI]: 18.1%-25.4%). The results of multivariable logistic regression analysis indicated that age of at least 60 (adjusted odd ratio [aOR] = 1.79, 95% CI: 1.04-3.08), and having diabetes specific complications (aOR = 4.78, 95% CI: 1.02-22.44) were risk factors for anxiety, and an educational level of high school or above (aOR = 0.55, 95% CI: 0.31-0.99), regular physical activity (aOR = 0.36, 95% CI: 0.22-0.58), and high social support (aOR = 0.30, 95% CI: 0.17-0.53) were protective factors for anxiety. A predictive model based on these five variables showed good performance (area under the curve = 0.80). Almost one in five inpatients with T2DM suffered from anxiety in China. Age, educational level, regular physical activity, diabetes specific complications, and social support were independently associated with anxiety.
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Affiliation(s)
- Rehanguli Maimaitituerxun
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
- Hunan Provincial Key Laboratory of Clinical Epidemiology, Changsha, Hunan, China
| | - Wenhang Chen
- Department of Nephrology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Jingsha Xiang
- Department of Human Resources, Central Hospital, Shandong First Medical University, Jinan, Shandong, China
| | - Yu Xie
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
- Hunan Provincial Key Laboratory of Clinical Epidemiology, Changsha, Hunan, China
| | - Atipatsa C Kaminga
- Department of Mathematics and Statistics, Mzuzu University, Mzuzu, Malawi
| | - Xin Yin Wu
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
- Hunan Provincial Key Laboratory of Clinical Epidemiology, Changsha, Hunan, China
| | - Letao Chen
- Infection Control Center, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Jianzhou Yang
- Department of Preventive Medicine, Changzhi Medical College, Changzhi, Shanxi, China
| | - Aizhong Liu
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
- Hunan Provincial Key Laboratory of Clinical Epidemiology, Changsha, Hunan, China
| | - Wenjie Dai
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan, China.
- Hunan Provincial Key Laboratory of Clinical Epidemiology, Changsha, Hunan, China.
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Tavares Franquez R, Del Grossi Moura M, Cristina Ferreira McClung D, Barberato-Filho S, Cruz Lopes L, Silva MT, de Sá Del-Fiol F, de Cássia Bergamaschi C. E-Health technologies for treatment of depression, anxiety and emotional distress in person with diabetes mellitus: A systematic review and meta-analysis. Diabetes Res Clin Pract 2023; 203:110854. [PMID: 37499879 DOI: 10.1016/j.diabres.2023.110854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 07/03/2023] [Accepted: 07/25/2023] [Indexed: 07/29/2023]
Abstract
OBJECTIVE This systematic review of randomized clinical trials (RCT) summarized the available evidence regarding the use of e-Health technologies for the treatment of depression, anxiety, and emotional distress in person with diabetes mellitus. METHODS The Cochrane CENTRAL, MEDLINE, EMBASE, Web of Science and LILACS databases searched were up to January 11th, 2023. The primary outcomes were improvement of depression, anxiety, diabetes-related emotional distress and quality of life. Reviewers, in pairs and independently, selected the studies and extracted their data. RESULTS A total of 10 RCT involving 2,209 participants were analyzed. The methodological quality of the studies reviewed was high. Results showed improvements in depression with the use of Internet-Guided Self-Help (SMD = -0.74, 95%CI = -1.04 to -0.43) or Telephone-Delivered Cognitive Behavioral Therapy (CBT) (SMD = -0.42, 95%CI = -0.65 to -0.19); in anxiety with Internet-Guided Self-Help (SMD = -0.72, 95%CI = -1.02 to -0.42) or Diabetes-specific-CBT (SMD = -0.60, 95%CI = -1.18 to -0.02); and in emotional distress with Internet-Guided Self-Help (SMD = -0.72, 95%CI = -1.02 to -0.41) or Healthy Outcomes through Patient Empowerment (SMD = -0.26, 95%CI = -0.53 to 0.01) compared to usual care. CONCLUSION Due to heterogeneity in interventions, populations, follow-up time and outcomes, future RCT should be conducted to confirm these findings.
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Affiliation(s)
| | | | | | - Silvio Barberato-Filho
- Pharmaceutical Sciences Graduate Course, University of Sorocaba, Sorocaba, São Paulo, Brazil
| | - Luciane Cruz Lopes
- Pharmaceutical Sciences Graduate Course, University of Sorocaba, Sorocaba, São Paulo, Brazil
| | - Marcus Tolentino Silva
- Department of Public Health, Faculty of Health Sciences, University of Brasilia, Brasilia, Brazil
| | - Fernando de Sá Del-Fiol
- Pharmaceutical Sciences Graduate Course, University of Sorocaba, Sorocaba, São Paulo, Brazil
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Li Y, Buys N, Ferguson S, Li Z, Shi YC, Li L, Sun J. The evaluation of cognitive-behavioral therapy-based intervention on type 2 diabetes patients with comorbid metabolic syndrome: a randomized controlled trial. Diabetol Metab Syndr 2023; 15:158. [PMID: 37461057 PMCID: PMC10351126 DOI: 10.1186/s13098-023-01100-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 05/27/2023] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND Cognitive behavior therapy (CBT) has been applied in intervention research in diabetes patients with satisfying results. However, there was no research on type 2 diabetes (T2DM) patients with comorbidities. This study aimed to investigate the effectiveness of CBT on psychological variables, behavior variables, quality of life, sleep quality, and physical variables among adult T2DM patients with comorbid metabolic syndrome (MS). METHODS 281 patients aged 18-75 years were recruited from Ningbo First Hospital in China from October 2021 to March 2022. Patients were randomized to the intervention group (IG, N = 148) or control group (CG, N = 133). Patients in the IG received 12 CBT-based sessions during a six-month intervention time. Patients in the CG received the usual care only. Univariate General Linear Model was used to analyze the effect of CBT-based interventions. The analysis was conducted by SPSS Version 28. RESULTS Results indicated that CBT-based intervention was superior in the following aspects: relieving depression symptoms: IG (4.11 ± 4.35 vs. 1.99 ± 2.12), CG (3.40 ± 3.26 vs. 2.32 ± 1.88), interaction effect (F = 4.074, P = 0.044); enhancing diabetes self-care behaviors: IG (26.79 ± 12.18 vs. 37.49 ± 10.83), CG (25.82 ± 13.71 vs. 31.96 ± 11.72), interaction effect (F = 5.242, P = 0.022); promoting the efficacy of CBT: IG (47.45 ± 6.83 vs. 50.76 ± 4.98), CG (46.74 ± 6.94 vs. 47.87 ± 5.11), interaction effect (F = 5.198, P = 0.023); improving subjective sleep quality: IG (0.93 ± 0.68 vs. 0.69 ± 0.63), CG (1.03 ± 0.72 vs. 1.01 ± 0.68), interaction effect (F = 3.927, P = 0.048). CONCLUSIONS The CBT-based intervention was beneficial in improving depression symptoms, diabetes self-care behaviors, the efficacy of CBT, and sleep quality in T2DM patients with comorbid MS. The downtrend of body mass index, systolic blood pressure, diastolic pressure, and glycated hemoglobin was larger in the intervention group but not to a significant level. TRIAL REGISTRATION This study has been prospectively registered at Australia New Zealand Clinical Trials Registry (Registration ID: ACTRN12621001348842 website: https://www.anzctr.org.au/trial/MyTrial.aspx ).
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Affiliation(s)
- Yanni Li
- School of Medicine and Dentistry, Griffith University, Gold Coast, QLD, Q4222, Australia
| | - Nicholas Buys
- Griffith Health, Griffith University, Gold Coast, QLD, Australia
| | | | - Zhiyong Li
- School of Mechanical, Medical & Process Engineering, Queensland University of Technology, Brisbane, QLD, Australia
| | - Yan-Chuan Shi
- Neuroendocrinology Group, Garvan Institute of Medical Research, Faculty of Medicine and Health, University of New South Wales, 384 Victoria St, Darlinghurst, Australia
| | - Li Li
- Department of Endocrinology and Metabolism, Ningbo First Hospital, Ningbo, 315010, Zhejiang Province, China.
| | - Jing Sun
- School of Medicine and Dentistry, Griffith University, Gold Coast, QLD, Q4222, Australia.
- Institute for Integrated Intelligence and Systems, Griffith University, Gold Coast, QLD, Australia.
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia.
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Visagie E, Deacon E, Kok R. Exploring the role of CBT in the self-management of type 2 diabetes: A rapid review. Health SA 2023; 28:2254. [PMID: 37292235 PMCID: PMC10244871 DOI: 10.4102/hsag.v28i0.2254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 03/08/2023] [Indexed: 06/10/2023] Open
Abstract
Background Type 2 diabetes has been recognised as a global health concern: one that requires intervention to lessen the incumbrance caused by the chronic illness. This rapid review was conducted to determine the scientific evidence available on how Cognitive Behaviour Therapy (CBT) interventions improved the self-management of individuals with type 2 diabetes. Aim The aim of the review was to synthesise current scientific evidence regarding CBT-based interventions and self-management practices. Method The rapid review served as a framework to appraise current national and international literature. The researchers used Google Scholar, Journal Storage (JSTOR), PsycINFO, APA PsycArticles, SAGE journals and EBSCO Discovery Services to search for relevant studies. This was performed by employing keywords. Nine relevant studies were identified. The studies were heterogenous in methodology. Seven of the nine studies were conducted in developing countries. Results The study found that the context of developmental countries plays a significant role in the development of type 2 diabetes and requires tailored intervention because of socio-economic variabilities. The main themes identified in relation to improving self-management included: the characteristics of the CBT-based interventions, namely the format, duration, and outcomes, and identifying the techniques and components used in the CBT-based interventions. Conclusion The review emphasised the need to further investigate the role of CBT in improving self-management of type 2 diabetes, especially in a South African context. Contribution The review summarised the techniques that have proven to be effective for the self-management of type 2 diabetes.
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Affiliation(s)
- Elne Visagie
- Compress Research Focus Area, Faculty of Health Sciences, North-West University, Potchefstroom, South Africa
| | - Elmari Deacon
- Optentia Research Unit, Faculty of Health Sciences, North-West University, Potchefstroom, South Africa
| | - Rümando Kok
- Centre for Health and Human Performance (CHHP), Faculty of Health Sciences, North-West University, Potchefstroom, South Africa
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Racey M, Whitmore C, Alliston P, Cafazzo JA, Crawford A, Castle D, Dragonetti R, Fitzpatrick-Lewis D, Jovkovic M, Melamed OC, Naeem F, Senior P, Strudwick G, Ramdass S, Vien V, Selby P, Sherifali D. Technology-Supported Integrated Care Innovations to Support Diabetes and Mental Health Care: Scoping Review. JMIR Diabetes 2023; 8:e44652. [PMID: 37159256 PMCID: PMC10206630 DOI: 10.2196/44652] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 02/23/2023] [Accepted: 04/01/2023] [Indexed: 05/10/2023] Open
Abstract
BACKGROUND For individuals living with diabetes and its psychosocial comorbidities (eg, depression, anxiety, and distress), there remains limited access to interprofessional, integrated care that includes mental health support, education, and follow-up. Health technology, broadly defined as the application of organized knowledge or skill as software, devices, and systems to solve health problems and improve quality of life, is emerging as a means of addressing these gaps. There is thus a need to understand how such technologies are being used to support, educate, and help individuals living with co-occurring diabetes and mental health distress or disorder. OBJECTIVE The purpose of this scoping review was to (1) describe the literature on technology-enabled integrated interventions for diabetes and mental health; (2) apply frameworks from the Mental Health Commission of Canada and World Health Organization to elucidate the components, type, processes, and users of technology-enabled integrated interventions for diabetes and mental health; and (3) map the level of integration of interventions for diabetes and mental health. METHODS We searched 6 databases from inception to February 2022 for English-language, peer-reviewed studies of any design or type that used technology to actively support both diabetes and any mental health distress or disorder in succession or concurrently among people with diabetes (type 1 diabetes, type 2 diabetes, and gestational diabetes). Reviewers screened citations and extracted data including study characteristics and details about the technology and integration used. RESULTS We included 24 studies described in 38 publications. These studies were conducted in a range of settings and sites of care including both web-based and in-person settings. Studies were mostly website-based (n=13) and used technology for wellness and prevention (n=16) and intervention and treatment (n=15). The primary users of these technologies were clients and health care providers. All the included intervention studies (n=20) used technology for clinical integration, but only 7 studies also used the technology for professional integration. CONCLUSIONS The findings of this scoping review suggest that there is a growing body of literature on integrated care for diabetes and mental health enabled by technology. However, gaps still exist with how to best equip health care professionals with the knowledge and skills to offer integrated care. Future research is needed to continue to explore the purpose, level, and breadth of technology-enabled integration to facilitate an approach to overcome or address care fragmentation for diabetes and mental health and to understand how health technology can further drive the scale-up of innovative integrated interventions.
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Affiliation(s)
- Megan Racey
- McMaster Evidence Review and Synthesis Team, McMaster University, Hamilton, ON, Canada
- School of Nursing, McMaster University, Hamilton, ON, Canada
| | - Carly Whitmore
- School of Nursing, McMaster University, Hamilton, ON, Canada
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Paige Alliston
- McMaster Evidence Review and Synthesis Team, McMaster University, Hamilton, ON, Canada
| | - Joseph A Cafazzo
- Healthcare Human Factors, University Health Network, Toronto, ON, Canada
- eHealth Innovation, University Health Network, Toronto, ON, Canada
| | - Allison Crawford
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
| | - David Castle
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | | | | | - Milos Jovkovic
- McMaster Evidence Review and Synthesis Team, McMaster University, Hamilton, ON, Canada
| | - Osnat C Melamed
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Farooq Naeem
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
| | - Peter Senior
- Clinical Islet Transplant Program, University of Alberta, Edmonton, AB, Canada
- Department of Medicine, Division of Endocrinology, University of Alberta, Edmonton, AB, Canada
| | - Gillian Strudwick
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
| | - Seeta Ramdass
- Diabetes Action Canada, Toronto, ON, Canada
- McGill University, Montreal, QC, Canada
| | - Victor Vien
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
| | - Peter Selby
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Diana Sherifali
- McMaster Evidence Review and Synthesis Team, McMaster University, Hamilton, ON, Canada
- School of Nursing, McMaster University, Hamilton, ON, Canada
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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. Biopsychosoc Med 2023; 17:18. [PMID: 37150826 PMCID: PMC10165773 DOI: 10.1186/s13030-023-00274-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 04/18/2023] [Indexed: 05/09/2023] Open
Abstract
BACKGROUND Glycemic control is an important issue in the treatment of diabetic patients. However, traditional methods, such as medication (the usual treatment), have limitations. Cognitive behavioral therapy (CBT) might be a useful option to help control the glycemic condition. The effects can be revealed by systemic review or meta-analysis of randomized clinical trials (RCT). METHODS A systematic search and a meta-analysis for the RCT were done of the short- and long-term effects of CBT on the glycemic control of diabetic patients in a comparison with the usual treatment. Nineteen RCT studies and 3,885 diabetic patients were enrolled in this meta-analysis. Subgroup analyses of types 1 and 2 diabetes and individual and group CBT were also performed. RESULTS Patients treated with CBT showed no significant difference in HbA1c when compared to the usual treatment within six months. However, CBT was more effective in reducing HbA1c when compared to usual treatment with at least six months of treatment duration [standardized mean difference: -0.44 (95% confidence interval (CI): -0.63 ~ -0.25), Z = 4.49]. Subgroup analysis of type 1 and 2 diabetic patients supported a long-term effect of CBT on glycemic control [standardized mean difference: -0.85 (95% CI: -1.19 ~ -0.10), Z = 2.23, standardized mean difference: -0.33 (95% CI:-0.47 ~ -0.19), Z = 4.52, respectively]. CONCLUSIONS CBT would be a useful option for improving the glycemic control of diabetic patients undergoing long-term treatment. The advantages of the long-term effects of CBT should be considered by clinicians and staff.
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Affiliation(s)
- Na Dong
- The Affiliated Nanhua Hospital, Department of Endocrinology, Hengyang Medical School, University of South China, Hengyang, Hunan, 421002, China
| | - Xiaowei Wang
- Department of Endocrinology, People's Hospital of Xinchang County, Zhejiang Province, Xinchang, 312500, China
| | - Liu Yang
- Department of Internal Medicine, Wuhan University Hospital, Wuhan, 430072, Hubei, China.
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Wu ACL, Choy BNK. Psychological interventions to reduce intraocular pressure (IOP) in glaucoma patients: a review. Graefes Arch Clin Exp Ophthalmol 2023; 261:1215-1227. [PMID: 36441225 DOI: 10.1007/s00417-022-05912-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 10/07/2022] [Accepted: 11/12/2022] [Indexed: 11/29/2022] Open
Abstract
PURPOSE Glaucoma has been increasing recognised to cause significant mental health burden to patients while psychological factors also play important roles in the development and progression of glaucoma. This review presents the current evidence of the impact of psychological interventions in glaucoma patients to improve their holistic care in terms of both physical and mental health by modulating psychological symptoms and supporting glaucoma control. METHODS A literature search was conducted on PubMed for relevant studies up to February 2022. Types of psychological interventions include meditation, autogenic relaxation, music, hypnosis, motivational interviewing, psychological nursing and bright light exposure. Outcomes investigated were ocular parameters including intraocular pressure, mental health, patient motivation and satisfaction, and overall quality of life. RESULTS Seventeen studies investigating the effects of psychological interventions on improving the care of glaucoma patients were reviewed. Daily meditation for 30 to 60 min has been shown to be effective in improving glaucoma control in terms of reducing intraocular pressure by 1.5 to 6.1 mmHg and improving ocular perfusion and quality of life. The impacts of music, autogenic training and psychological nursing on glaucoma control, vision outcomes and psychological symptoms are also promising while bright light exposure has shown some effects on sleeping quality. However, there is insufficient basis to support the adoption of motivational interviewing or hypnosis in glaucoma patients yet. CONCLUSION Psychological interventions, especially meditation, can play a bigger role in the holistic care of glaucoma patients by controlling disease progression as an adjunct to conventional approaches and alleviating the mental health burden caused by the disease through stress reduction and emotional regulation. They empower patients to gain greater control of their disease and provides additional advantages of low cost, non-invasiveness and minimal side effects. Future research should involve well-conducted randomised trials with larger sample sizes and longer duration of intervention and follow-up to establish the long-term benefits for glaucoma patients.
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Affiliation(s)
- Anson Chun Long Wu
- LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Bonnie Nga Kwan Choy
- Department of Ophthalmology, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Room 301, Block B, Cyberport 4, 100 Cyberport Road, Hong Kong SAR, China.
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Wen Y, Han X, Sun M, Wang L, Zhu X, Wang X, Wang C. The anxiety and depression status and related influencing factors in patients with type 2 diabetes: Why should we care. JOURNAL OF RADIATION RESEARCH AND APPLIED SCIENCES 2023. [DOI: 10.1016/j.jrras.2022.100495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
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Velázquez-Jurado H, Flores-Torres A, Pérez-Peralta L, Salinas-Rivera E, Valle-Nava MD, Arcila-Martinez D, Hernández-Jiménez S. Cognitive behavioral treatment to improve psychological adjustment in people recently diagnosed with type 2 diabetes: Psychological treatment in type 2 diabetes. Health Psychol Behav Med 2023; 11:2179058. [PMID: 36846199 PMCID: PMC9946322 DOI: 10.1080/21642850.2023.2179058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023] Open
Abstract
Type 2 diabetes mellitus (T2DM) is a chronic disease that affects a person's general well-being. Current evidence sets an association between psychological well-being and controlled metabolic parameters. People newly diagnosed with T2DM show higher prevalence of depression and anxiety symptoms. Cognitive behavioral therapy (CBT) has effectively improved psychological adjustment, but most studies do not specifically address recently diagnosed people nor usually include long-term follow-up measures. Objective We sought to assess changes in psychological variables in people with newly diagnosed diabetes who received a cognitive-behavioral intervention, within a comprehensive care program. Method 1208 adults with T2DM (≤5 years) who attended a national health institute in Mexico received a cognitive-behavioral intervention aimed at improving quality of life and reducing emotional distress that often interferes with diabetes control, as well as evaluating cognitive and emotional resources and social support. Measures of quality of life, diabetes-related distress, anxiety and depression questionnaires were compared at pre-test, post-test and follow up using Friedman's ANOVAs. Multiple logistic regression models evaluated glycosylated hemoglobin (HbA1c) and triglycerides control at post-test and follow up. Results Questionnaire measures and metabolic variables significantly decreased symptomatology at post-test and these changes maintained at follow-up. Significant associations were found between quality-of-life scores and HbA1c and triglycerides levels in post-test and follow-up. Diabetes-related distress scores increased the odds of having adequate HbA1c control at post-test. Conclusion This study contributes to the evidence on the importance of considering psychological factors as part of comprehensive diabetes care to improve quality of life and emotional burden and facilitate the achievement of metabolic goals.
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Affiliation(s)
- Héctor Velázquez-Jurado
- Centre for the Comprehensive Care of the Patient with Diabetes, National Institute of Medical Sciences and Nutrition Salvador Zubirán, Mexico City, Mexico,Postgraduate Studies Division, National Autonomous University of Mexico (UNAM), Mexico City, Mexico, Héctor Velázquez-Jurado Centre for the Comprehensive Care of the Patient with Diabetes, National Institute of Medical Sciences and Nutrition Salvador Zubirán, Mexico City, Mexico; National Autonomous University of Mexico, Mexico City, Mexico; Av. Vasco de Quiroga #15, Col. Belisario Dominguez, Sección XVI, Alc. Tlalpan, C.P. 14080, Ciudad de Mexico
| | - Athena Flores-Torres
- Postgraduate Studies Division, National Autonomous University of Mexico (UNAM), Mexico City, Mexico
| | - Liliana Pérez-Peralta
- Centre for the Comprehensive Care of the Patient with Diabetes, National Institute of Medical Sciences and Nutrition Salvador Zubirán, Mexico City, Mexico
| | - Edgar Salinas-Rivera
- Department of Educational Psychology, National Pedagogic University (UPN), Mexico City, Mexico
| | - Marianne Daniela Valle-Nava
- Centre for the Comprehensive Care of the Patient with Diabetes, National Institute of Medical Sciences and Nutrition Salvador Zubirán, Mexico City, Mexico,Postgraduate Studies Division, National Autonomous University of Mexico (UNAM), Mexico City, Mexico
| | - Denise Arcila-Martinez
- Centre for the Comprehensive Care of the Patient with Diabetes, National Institute of Medical Sciences and Nutrition Salvador Zubirán, Mexico City, Mexico
| | - Sergio Hernández-Jiménez
- Centre for the Comprehensive Care of the Patient with Diabetes, National Institute of Medical Sciences and Nutrition Salvador Zubirán, Mexico City, Mexico
| | - for the CAIPaDi Study Group
- Centre for the Comprehensive Care of the Patient with Diabetes, National Institute of Medical Sciences and Nutrition Salvador Zubirán, Mexico City, Mexico
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27
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Franquez RT, de Souza IM, Bergamaschi CDC. Interventions for depression and anxiety among people with diabetes mellitus: Review of systematic reviews. PLoS One 2023; 18:e0281376. [PMID: 36758047 PMCID: PMC9910656 DOI: 10.1371/journal.pone.0281376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 01/20/2023] [Indexed: 02/10/2023] Open
Abstract
This review of systematic reviews of randomized clinical trials summarized the available evidence regarding the effectiveness and safety of interventions to treat depression and/or anxiety in people with type 1 and type 2 diabetes. The sources of information searched were the Cochrane Library, MEDLINE, EMBASE, Web of Science and LILACS, until up to December 1st, 2022. The interventions were compared with placebo, active control or usual care. The measured primary outcomes were improvement in depression and anxiety remission, reduction of diabetes-specific emotional distress; and improvement in quality of life. Two reviewers, independently, selected the reviews, extracted their data, and assessed their methodological quality using AMSTAR-2. A narrative synthesis of the findings was performed, according to the type of intervention and type of diabetes. Thirteen systematic reviews that included 28,307 participants were analyzed. The reviews had at least one critical methodological flaw. Cognitive Behavioral Therapy improved the mainly depression, glycemic values (n = 5 reviews) and anxiety (n = 1), in adults and elderly with diabetes. Collaborative care (n = 2) and health education (n = 1) improved depression and glycemic values, in adults with diabetes. Pharmacological treatment (n = 2) improved depression outcomes only. The quality of the evidence was low to moderate, when reported. The interventions reported in literature and mainly the Cognitive Behavioral Therapy can be effective to treat people with diabetes and depression; however, some findings must be confirmed. This study can guide patients, their caregivers and health professionals in making decisions concerning the use of these interventions in the mental healthcare of people with diabetes. Protocol Registration: PROSPERO (CRD42021224587).
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Affiliation(s)
| | - Isabela Muniz de Souza
- Pharmaceutical Sciences Graduate Course, University of Sorocaba, Sorocaba, São Paulo, Brazil
- Dental School, University of Sorocaba, Sorocaba, São Paulo, Brazil
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Cognitive behavior therapy as dermatological treatment: a narrative review. Int J Womens Dermatol 2022; 8:e068. [PMID: 36601597 PMCID: PMC9788967 DOI: 10.1097/jw9.0000000000000068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 11/02/2022] [Indexed: 12/24/2022] Open
Abstract
Cognitive behavior therapy (CBT) is efficacious in treating numerous psychological disorders. It is also effective in combination with medication for chronic pain, diabetes, and other diseases. Patients with skin disease report high levels of stress, anxiety, and negative feelings. Objective To summarize the findings on the utility of CBT for the improvement of skin status and quality of life in patients with dermatological conditions. Methods PubMed and Google Scholar databases were searched for relevant articles from database inception to the time of search (October 20, 2021). A total of 30 included studies featured 10 on psoriasis, 11 on atopic dermatitis, 4 on vitiligo, 4 on acne, and 1 study on alopecia areata. Results Several studies, including randomized controlled trials with large study samples, support the effectiveness of CBT and Internet CBT for a number of dermatological conditions. Patients who completed CBT courses were less likely to rely on dermatological healthcare during follow-up. Limitations There are a limited number of studies discussing the implementation of CBT for alopecia, acne, and vitiligo. Conclusion Patients who underwent CBT or Internet CBT in addition to skin care demonstrated improvement with quality of life and severity of skin disease as compared to controls only receiving standard of care treatment.
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Barana L, Colleluori G, Sulpizi MT, Ortenzi K, Farano L, Fanelli CG, Calafiore R, Dalla Ragione L, Pampanelli S. Efficacy of the holistic, psychonutritional approach of Centro DAI e Obesità di Città della Pieve in the management of type 2 diabetes among patients with obesity and dysfunctional eating. J Diabetes Metab Disord 2022; 21:1883-1893. [PMID: 35891980 PMCID: PMC9305049 DOI: 10.1007/s40200-022-01085-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 06/29/2022] [Indexed: 12/04/2022]
Abstract
Purpose Dysfunctional eating is strongly associated with obesity and worsens type 2 diabetes (T2DM) outcomes. The aim of this study was to investigate the effectiveness of the psycho-nutritional treatment (PNT) of "Centro DAI e Obesità" of Città della Pieve on weight loss and glucose management in dysfunctional eaters with obesity and T2DM. Methods PNT includes psychotherapeutical, nutritional, physical and social activities. Subjects with obesity, T2DM and dysfunctional eating habits who completed the 8 weeks residential program between 2010 and 2019 were compared with obese, T2DM, dysfunctional eaters who underwent to a conventional, hospital-based, nutritional treatment (CT). Anthropometric variables, glucolipid panel, and body composition were assessed at baseline and at the end of the program. Weight and HbA1c were also measured after one year from the completion. Results Sixty-nine patients completed the PNT and reduced weight (-7 ± 3.2%; p < 0.001), BMI (-7 ± 3.1%; p < 0.001), and triglycerides, AST, GGT and ALT (p ≤ 0.008); glycemic control improved (HbA1c: -1.1 ± 1.5%, mean fasting glucose: -41 ± 46 mg/dl, p < 0.001). Eleven% of subjects requiring diabetes medications at baseline discontinued the therapy. In the insulin treated group (49%), mean daily units were halved (-32.6 ± 26.0, p < 0.001). At one year, weight loss (-6 ± 7.4%, p < 0.001) and HbA1c reduction (-0.52 ± 1.4%, p = 0.029) persisted. Fifty-five patients completed the CT: HbA1c reduced (p = 0.02), but weight (-0.6 ± 3.7%), BMI (-0.7 ± 3.8%), and insulin units' reduction (-2.5 ± 11.7, p = 0.20) were lower compared to the PNT. Conclusion PNT is effective in improving T2DM management in patients with obesity and dysfunctional eating.
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Affiliation(s)
- Luisa Barana
- Section of Endocrinology and Metabolism, Department of Medicine, University of Perugia, Piazzale Gambuli 1, 06129 Perugia, Italy
- Centro DAI e Obesità of Città della Pieve, USL Umbria1 Città della Pieve, Via Beato Giacomo Villa 1, 06062 Città della Pieve, PG Italy
| | - Georgia Colleluori
- Centro DAI e Obesità of Città della Pieve, USL Umbria1 Città della Pieve, Via Beato Giacomo Villa 1, 06062 Città della Pieve, PG Italy
- Center for the Study of Obesity, Department of Experimental and Clinical Medicine, Marche Polytechnic University, via Tronto 10 A, 60020 Ancona, Italy
| | - Maria Teresa Sulpizi
- Section of Endocrinology and Metabolism, Department of Medicine, University of Perugia, Piazzale Gambuli 1, 06129 Perugia, Italy
| | - Kathleen Ortenzi
- Center for the Study of Obesity, Department of Experimental and Clinical Medicine, Marche Polytechnic University, via Tronto 10 A, 60020 Ancona, Italy
| | - Luca Farano
- Center for the Study of Obesity, Department of Experimental and Clinical Medicine, Marche Polytechnic University, via Tronto 10 A, 60020 Ancona, Italy
| | - Carmine Giuseppe Fanelli
- Section of Endocrinology and Metabolism, Department of Medicine, University of Perugia, Piazzale Gambuli 1, 06129 Perugia, Italy
| | - Riccardo Calafiore
- Section of Endocrinology and Metabolism, Department of Medicine, University of Perugia, Piazzale Gambuli 1, 06129 Perugia, Italy
| | - Laura Dalla Ragione
- Center for the Study of Obesity, Department of Experimental and Clinical Medicine, Marche Polytechnic University, via Tronto 10 A, 60020 Ancona, Italy
| | - Simone Pampanelli
- Center for the Study of Obesity, Department of Experimental and Clinical Medicine, Marche Polytechnic University, via Tronto 10 A, 60020 Ancona, Italy
- U.O. M.I.S.E.M., Torre Ellittica piano +1, Ospedale S.Maria della Misericordia, Piazza Lucio Severi 1/8, 06129 S.Andrea delle Fratte, Perugia, PG Italy
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Hsia J, Guthrie NL, Lupinacci P, Gubbi A, Denham D, Berman MA, Bonaca MP. Randomized, Controlled Trial of a Digital Behavioral Therapeutic Application to Improve Glycemic Control in Adults With Type 2 Diabetes. Diabetes Care 2022; 45:2976-2981. [PMID: 36181554 PMCID: PMC9862458 DOI: 10.2337/dc22-1099] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 08/29/2022] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To evaluate the efficacy and safety of a digital therapeutic application (app) delivering cognitive behavioral therapy (CBT) designed to improve glycemic control in patients with type 2 diabetes. RESEARCH DESIGN AND METHODS Adults with type 2 diabetes and an HbA1c of 7 to <11% were randomly assigned to receive access to a digital therapeutic app delivering CBT (BT-001) or a control app, both on top of standard of care management. CBT is an established form of psychological treatment that endeavors to identify and change unhelpful thinking patterns. The primary study end point was treatment group difference in mean HbA1c change from baseline to 90 days. RESULTS Among 669 randomly assigned subjects who completed app onboarding, the mean age was 58 years, BMI 35 kg/m2, 54% were female, 28% Black, and 16% Latino. Baseline HbA1c was 8.2 and 8.1% in the BT-001 and control groups, respectively. After 90 days of app access, change in HbA1c was -0.28% (95% CI -0.41, -0.15) in the BT-001 group and +0.11% (95% CI -0.02, 0.23) in the control group (treatment group difference 0.39%; P < 0.0001). HbA1c reduction paralleled exposure to the therapeutic intervention, assessed as the number of modules completed on the app (P for trend <0.0001). No adverse events in either group were attributed to app use and no adverse device effects reported. CONCLUSIONS Patients randomly assigned to the BT-001 arm relative to the control arm had significantly lower HbA1c at 90 days. The digital therapeutic may provide a scalable treatment option for patients with type 2 diabetes.
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Affiliation(s)
- Judith Hsia
- CPC Clinical Research, Aurora, CO.,University of Colorado School of Medicine, Aurora, CO
| | | | | | | | | | | | - Marc P Bonaca
- CPC Clinical Research, Aurora, CO.,University of Colorado School of Medicine, Aurora, CO
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Zuo X, Dong Z, Zhang P, Zhang P, Zhu X, Qiao C, Yang Y, Lou P. Cognitive-behavioral therapy on psychological stress and quality of life in subjects with pulmonary tuberculosis: a community-based cluster randomized controlled trial. BMC Public Health 2022; 22:2160. [DOI: 10.1186/s12889-022-14631-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 11/15/2022] [Indexed: 11/25/2022] Open
Abstract
Abstract
Background
Anxiety and depression are two common psychological disorders in patients with pulmonary tuberculosis. We aimed to explore the effects of cognitive-behavioral therapy (CBT) on psychological stress and quality of life in patients with pulmonary tuberculosis.
Methods
From September 2018 to November 2018, 20 communities (461 participants in total) were randomly assigned in an intervention or control group following a two-level cluster random design. The intervention group underwent CBT for 2 months, whereas the control group received routine follow-up. Anxiety, depression, and quality of life were assessed using the Patient Health Questionnaire-9 (PHQ-9), General Anxiety Disorder questionnaire (GAD-7), and 36-Item Short-Form Health Survey (SF-36) scales, respectively. Comparisons between the two groups were conducted using independent samples t-tests, and differences between the two groups before and after treatment were analyzed using paired samples t-tests.
Results
There were a total of 454 participants in the final analysis. After 2 months of CBT intervention, the CBT group had a GAD-7 score that was 1.72 lower than the control group (1.47–1.99, p < 0.001), a PHQ-9 score of the CBT group that was 2.05 lower than that of the control group (1.74–2.37, p < 0.001). The CBT group had a total SF-36 score that was 10.7 lower than that of the control group (95% CI: 7.9–13.5, p < 0.001). In patients with different degrees of anxiety and depression, only those in the intervention group who had mild and moderate anxiety and depression symptoms showed a significant reduction in anxiety and depression scores following the intervention.
Conclusions
CBT can relieve anxiety, and depression symptoms and increase the quality of life in subjects with pulmonary tuberculosis.
Trials registration
ChiCTR-TRC-12001958 Date of Registration: 22/02/2012.
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Jenkinson E, Knoop I, Hudson JL, Moss‐Morris 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. Diabet Med 2022; 39:e14948. [PMID: 36031793 PMCID: PMC9826380 DOI: 10.1111/dme.14948] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 08/25/2022] [Indexed: 01/11/2023]
Abstract
AIM Diabetes-related distress is common in diabetes and has implications for well-being. Cognitive behavioural therapy (CBT) and third-wave CBT hold promise as treatments for diabetes-related distress, although previous findings are inconclusive. We aimed to conduct a systematic review with meta-analysis to understand the efficacy of these interventions in treating diabetes-related distress, while also assessing the associative benefits of these interventions on depression, anxiety and glycaemic control. We also aimed to conduct a narrative synthesis, and subgroup analyses to identify intervention components most useful in treating diabetes-related distress. METHOD We searched seven electronic databases from inception to April 2021. Data extraction was independently performed by two reviewers. Methodological quality was assessed. The protocol was registered with the Prospective Register Of Systematic Reviews (PROSPERO): CRD42021240628. RESULTS We included 22 randomised controlled trials investigating the efficacy of CBT and third-wave CBT interventions on diabetes-related distress. CBT for diabetes-related distress significantly reduced distress (SMD = -0.278, p = 0.010) and depression (SMD = -0.604, p = 0.016). Third-wave CBT for diabetes-related distress significantly reduced anxiety (SMD = -0.451, p = 0.034). No significant effect of either intervention on glycated haemoglobin was observed. CBT interventions that included a digital component, were delivered by a psychological practitioner, and included behavioural activation bolstered the effects on diabetes-related distress. CONCLUSIONS CBT aiming to target diabetes-related distress is beneficial for distress and depression. Third-wave CBT for diabetes-related distress is beneficial for anxiety. More work is needed to optimise interventions to improve both mental and physical health outcomes in people with diabetes.
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Affiliation(s)
- Emma Jenkinson
- Health Psychology Section, Department of PsychologyInstitute of Psychiatry, Psychology and Neuroscience, King's College LondonLondonUK
| | - Iris Knoop
- Health Psychology Section, Department of PsychologyInstitute of Psychiatry, Psychology and Neuroscience, King's College LondonLondonUK
| | - Joanna L. Hudson
- Health Psychology Section, Department of PsychologyInstitute of Psychiatry, Psychology and Neuroscience, King's College LondonLondonUK
| | - Rona Moss‐Morris
- Health Psychology Section, Department of PsychologyInstitute of Psychiatry, Psychology and Neuroscience, King's College LondonLondonUK
| | - Ruth A. Hackett
- Health Psychology Section, Department of PsychologyInstitute of Psychiatry, Psychology and Neuroscience, King's College LondonLondonUK
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Gomille-Hahn L, Grammes J, Lehnart J, Binz C, Koehn S, Kubiak T, Benecke A. Reduktion von diabetesbezogenem Distress bei Typ-1- und Typ-2-Diabetes durch eine kognitiv-verhaltenstherapeutische Gruppenintervention. DIABETOL STOFFWECHS 2022. [DOI: 10.1055/a-1928-9691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
ZusammenfassungDas Stresserleben durch die Erkrankung Diabetes mellitus stellt für einen Großteil der betroffenen Personen oft eine deutliche Belastung dar, die sich negativ auf das Diabetes-Selbstmanagement und damit auf die Gesundheit der Betroffenen auswirken kann. Das Ziel der vorliegenden Studie war die Evaluation einer diabetesspezifischen kognitiv-verhaltenstherapeutischen Gruppentherapie zur Reduktion des Stresserlebens, bestehend aus sechs Sitzungen für Personen mit Typ-1- oder Typ-2-Diabetes. Vermittelt wurden Techniken zur Stressbewältigung, wie Achtsamkeit und Entspannungsübungen, sowie kognitive Techniken, die auf den Alltag mit der Diabeteserkrankung und damit verbundene Gedanken und Emotionen der Teilnehmenden bezogen waren. Von 52 Personen (51,9% mit Typ-1-Diabetes, 61,5% weiblich, Alter MW= 50,4 Jahre) lagen nach Studienteilnahme Fragebögen vor. Eine signifikante Verbesserung konnte im Problem Areas In Diabetes Questionnaire (Δ6.24 [95%-KI: 1.85–10.62], p=.006), dem Perceived Stress Survey (Δ2.93 [95%-KI: 1.59–4.26], p=.000) und der Diabetes Acceptance Scale (Δ5.5 [95%-KI: 9.07–1.93], p=.003) erreicht werden. Diese erwies sich auch im Follow-Up nach sechs Monaten als stabil. Der selbstberichtete HbA1c-Wert reduzierte sich im Befragungszeitraum bei der Teilstichprobe von N= 40, von der die Daten verfügbar waren, ebenfalls signifikant (Δ0.73 [95%-KI: 0.015–1.452], p=.046). Das Gruppentherapieprogramm zur Stressreduktion kann als eine niedrigschwellige, psychotherapeutische Interventionen zur Reduktion diabetesbezogener Belastungen angesehen werden. Es könnte ein hilfreiches primär- und sekundärpräventives Angebot für stressbelastete Menschen mit Diabetes in der Standardversorgung darstellen.
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Affiliation(s)
- Lara Gomille-Hahn
- Poliklinische Institutsambulanz für Psychotherapie, Johannes Gutenberg Universität Mainz, Mainz, Germany
| | - Jennifer Grammes
- Gesundheitspsychologie, Johannes Gutenberg-Universität, Mainz, Germany
- c/o IDT, Arbeitsgemeinschaft Diabetes und Technologie der Deutschen Diabetes Gesellschaft, Ulm, Germany
| | - Judith Lehnart
- Soziale Arbeit und Sozialwissenschaften, Katholische Hochschule Mainz, Mainz, Germany
| | - Christine Binz
- Poliklinische Institutsambulanz für Psychotherapie, Johannes Gutenberg Universität Mainz, Mainz, Germany
| | - Sandra Koehn
- Poliklinische Institutsambulanz für Psychotherapie, Johannes Gutenberg Universität Mainz, Mainz, Germany
| | - Thomas Kubiak
- Gesundheitspsychologie, Johannes Gutenberg-Universität, Mainz, Germany
| | - Andrea Benecke
- Poliklinische Institutsambulanz für Psychotherapie, Johannes Gutenberg Universität Mainz, Mainz, Germany
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Carreira M, Ruiz de Adana MS, Pinzón JL, Anarte-Ortiz MT. Internet-based Cognitive-behavioral therapy (CBT) for depressive symptomatology in individuals with type 1 diabetes (WEB_TDDI1 study): A randomized controlled trial protocol. PLoS One 2022; 17:e0274551. [PMID: 36126050 PMCID: PMC9488778 DOI: 10.1371/journal.pone.0274551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 08/19/2022] [Indexed: 11/19/2022] Open
Abstract
Background Professionals need adequate tools to help patients with diabetes and depression. Although web programs integrating cognitive-behavioral therapy with diabetes education have shown good results, no similar approach has been performed as yet in Spain. The objective is to develop an Internet-based program for the treatment of mild-moderate depressive symptomatology in individuals with type 1 diabetes (WEB_TDDI1 study) based on Cognitive-behavioral therapy (CBT) and assess its results. Methods A 2-arm randomized controlled trial will be conducted. Adults with type 1 diabetes and mild-moderate depressive symptoms will be screened to participate in the study and randomly assigned to either the treatment group (TG) that will use a Web-based application for a specific 9-week intervention in depression and type 1 diabetes or the control group (CG) that will be on the waiting list during that time. Results Data on the primary variable (depressive symptoms) and secondary variables (treatment-related distress, anxiety, fear of hypoglycemia, quality of life, treatment adherence, coping strategies and glycemic control) will be collected from the TG at the beginning/baseline, at the end of treatment and at 3, 6 and 12 months after treatment. The CG will be assessed at the beginning and at the end of the TG intervention. On completion of the program by the TG, the treatment will then be carried out in the CG. Conclusions The new web application developed is expected to be effective for the treatment of mild-moderate depressive symptoms in adults with type 1 diabetes, reducing depressive symptoms and improving the rest of the analyzed variables. Trial registration Registry: NCT03473704 (March 21, 2018); ClinicalTrials.gov.
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Affiliation(s)
- Mónica Carreira
- Department of Personality, Assessment and Psychological Treatment, Biomedical Research Institute of Malaga (IBIMA), University of Malaga, Málaga, Spain
| | - María Soledad Ruiz de Adana
- Clinical Management Unit of Endocrinology and Nutrition, Biomedical Research Institute of Malaga (IBIMA), Regional University Hospital, University of Malaga, Málaga, Spain
| | - José Luis Pinzón
- Clinical Management Unit of Endocrinology and Nutrition, Biomedical Research Institute of Malaga (IBIMA), Virgen de la Victoria University Hospital, University of Malaga, Málaga, Spain
| | - María Teresa Anarte-Ortiz
- Department of Personality, Assessment and Psychological Treatment, Biomedical Research Institute of Malaga (IBIMA), University of Malaga, Málaga, Spain
- * E-mail:
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MacGregor KL, DeMartini KS, Barry-Menkhaus SA, Derr AG, Thompson MJ. The Impact of Integrated Behavioral Healthcare on Glycemic Control. J Clin Psychol Med Settings 2022; 29:636-644. [PMID: 34436717 DOI: 10.1007/s10880-021-09817-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/20/2021] [Indexed: 10/20/2022]
Abstract
Integrated behavioral healthcare (IBH) is the "standard of care" to address psychosocial factors impacting diabetes outcomes; it is not standard in practice. This longitudinal, retrospective, chart-review examines IBH impact on glycemic control in an adult diabetes clinic. Adults (n = 374) with ≥ 1 behavioral health encounter, ≥ 2 hemoglobin A1c (HbA1c) values, and HbA1c value > 8% at initial IBH visit were included. Mixed effects linear piecewise models examined differences in slope trajectories for 365 days pre- and post-IBH intervention. Pre-intervention slope was not significant (z = - 1.09, p = 0.28). The post-intervention slope was significant (z = - 6.44, p < 0.001), indicating a significant linear decrease in HbA1c values. Results demonstrated that prior to engaging with behavioral health, there was no change in HbA1c. After initial IBH visit, there was a predicted reduction of > 1% in HbA1c over the following year. These results suggest that IBH significantly improves patients' metabolic status. Next steps for IBH research are offered.
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Affiliation(s)
- Kristin L MacGregor
- Department of Psychiatry/Diabetes Center of Excellence, UMass Memorial Medical Center/UMass Medical School, Worcester, MA, 01655, USA.
| | - Kelly S DeMartini
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, 06510, USA
| | | | - Alan G Derr
- Diabetes Center of Excellence, UMass Medical School, Worcester, MA, 01655, USA
| | - Michael J Thompson
- Diabetes Center of Excellence, UMass Medical School, Worcester, MA, 01655, USA
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Jin CY, Yu SW, Yin JT, Yuan XY, Wang XG. Corresponding risk factors between cognitive impairment and type 1 diabetes mellitus: a narrative review. Heliyon 2022; 8:e10073. [PMID: 35991978 PMCID: PMC9389196 DOI: 10.1016/j.heliyon.2022.e10073] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 04/24/2022] [Accepted: 07/20/2022] [Indexed: 11/30/2022] Open
Abstract
Type 1 diabetes mellitus (T1DM) is a type of diabetes caused by the destruction of pancreatic β cells and the absolute lack of insulin secretion. T1DM usually starts in adolescence or develops directly as a severe disease state of ketoacidosis. T1DM and its complications make many people suffer and have psychological problems, which make us have to pay more attention to the prevention and early control of T1DM. Cognitive impairment (CI) is one of the major complications of T1DM. It can further develop into Alzheimer's disease, which can seriously affect the quality of life of the elderly. Furthermore, the relationship between T1DM and CI is unclear. Hence, we conducted a narrative review of the existing literature through a PubMed search. We summarized some risk factors that may be associated with the cognitive changes in T1DM patients, including onset age and duration, education and gender, glycemic states, microvascular complications, glycemic control, neuropsychology and emotion, intestinal flora, dyslipidemia, sleep quality. We aimed to provide some content related to CI in T1DM, and hoped that it could play a role in early prediction and treatment to reduce the prevalence.
Corresponding risk factors between cognitive impairment and type 1 diabetes mellitus. Duration and age; Education and gender and Glycemic states. Diabetic ketoacidosis; Microvascular complications and Glycemic control–HbA1c. Neuropsychology and emotion; Intestinal flora; Dyslipidemia and Sleep Quality.
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Affiliation(s)
- Chen-Yang Jin
- The First Affiliated Hospital of Dalian Medical University, Dalian Medical University, Dalian 116011, PR China
| | - Shi-Wen Yu
- The First Affiliated Hospital of Dalian Medical University, Dalian Medical University, Dalian 116011, PR China
| | - Jun-Ting Yin
- The Second Affiliated Hospital of Dalian Medical University, Dalian Medical University, Dalian 116027, PR China
| | - Xiao-Ying Yuan
- Department of Anatomy, College of Basic Medicine, Dalian Medical University, Dalian 116044, PR China
- Department of Surgery, The Affiliated Zhongshan Hospital of Dalian University, Dalian 116001, PR China
- Corresponding author.
| | - Xu-Gang Wang
- Department of Neurology, The Second Affiliated Hospital of Dalian Medical University, Dalian 116027, PR China
- Corresponding author.
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Mather S, Fisher P, Nevitt S, Cherry MG, Maturana C, Warren JG, Noble A. The limited efficacy of psychological interventions for depression in people with Type 1 or Type 2 diabetes: An Individual Participant Data Meta-Analysis (IPD-MA). J Affect Disord 2022; 310:25-31. [PMID: 35490884 DOI: 10.1016/j.jad.2022.04.132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 04/12/2022] [Accepted: 04/20/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND People with either Type 1/Type 2 diabetes experiencing anxiety or depression experience worse clinical and social outcomes. Efficacy of available psychological and pharmacological treatments for anxiety and depression is unclear. Aggregate data meta-analyses (AD-MAs) have failed to consider the clinical relevance of any change these treatments elicit. Thus, we sought to complete an individual participant data meta-analysis (IPD-MA) to evaluate this. METHODS Eligible RCTs of psychological treatments (PTs) and pharmacological treatments (PhTs) were systematically identified and assessed using the Cochrane Risk of Bias Tool-2. IPD was requested and Jacobson's methodology was used to determine the clinical relevance of symptom-change. Traditional effect sizes were calculated to permit comparison of trials providing and not providing IPD and to compare with AD-MAs. RESULTS Sufficient data was obtained to conduct an IPD-MA for PTs (12/25) but not PhTs (1/5). Across PT trials, rates of 'recovery' for depression post-intervention were low. Whilst significantly more treated patients did recover (17% [95% CI 0.10, 0.25]) than controls (9% [95% CI 0.03, 0.17]), the difference was small (6% [95% CI 0.02, 0.10]). LIMITATIONS Only 50% of eligible trials provided IPD; we were also only able to examine outcomes immediately following the end of an intervention. CONCLUSION Current psychological interventions offer limited benefit in treating anxiety and depression in people with Type 1 or Type 2 diabetes (83% remain depressed). More efficacious interventions are urgently needed.
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Affiliation(s)
- Sarah Mather
- Department of Public Health, Policy and Systems, University of Liverpool, United Kingdom of Great Britain and Northern Ireland; Department of Psychology, University of Liverpool, United Kingdom of Great Britain and Northern Ireland.
| | - Peter Fisher
- Department of Primary Care and Mental Health, University of Liverpool, United Kingdom of Great Britain and Northern Ireland
| | - Sarah Nevitt
- Department of Health Data Science, University of Liverpool, United Kingdom of Great Britain and Northern Ireland
| | - Mary Gemma Cherry
- Department of Primary Care and Mental Health, University of Liverpool, United Kingdom of Great Britain and Northern Ireland
| | - Camila Maturana
- Department of Health Sciences, University of York, United Kingdom of Great Britain and Northern Ireland
| | - Jasmine G Warren
- Department of Psychology, University of Liverpool, United Kingdom of Great Britain and Northern Ireland
| | - Adam Noble
- Department of Public Health, Policy and Systems, University of Liverpool, United Kingdom of Great Britain and Northern Ireland
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Li Y, Storch EA, Ferguson S, Li L, Buys N, Sun J. The efficacy of cognitive behavioral therapy-based intervention on patients with diabetes: A meta-analysis. Diabetes Res Clin Pract 2022; 189:109965. [PMID: 35718018 DOI: 10.1016/j.diabres.2022.109965] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 03/10/2022] [Accepted: 06/13/2022] [Indexed: 11/28/2022]
Abstract
AIMS This meta-analysis aims to update former meta-analyses from randomized controlled trials (RCT) focused on the efficacy of CBT for diabetes. METHODS Five databases were searched for RCTs. Primary outcomes were glycated hemoglobin (HbA1c), fasting blood glucose (FBS), systolic blood pressure (SBP), diastolic blood pressure (DBP), and body mass index (BMI). Secondary outcomes were depression, anxiety and distress symptoms, quality of life, sleep quality. RESULTS 32 RCTs were included. Results revealed that CBT could reduce HbA1c: -0.14% (95% CI: -0.25 to -0.02%, P = 0.020); FBS: -15.48 mg/dl (95% CI: -30.16 to -0.81 mg/dl, P = 0.040); DBP: -2.88 mmHg (95% CI: -4.08 to -1.69 mmHg, P < 0.001); depression symptoms: -0.90 (95% CI: -1.22 to -0.57, P < 0.001); anxiety symptoms: -0.28 (95% CI: -0.50 to -0.07, P = 0.009); improve sleep quality: -0.92 (95% CI: -1.77 to -0.07, P = 0.030). Subgroup analysis indicated that CBT has siginificantly reduced HbA1c when delivered as a group-based and face-to-face method, and psycho-education, behavioral, cognitive, goal-setting, homework assignment strategies were applied as central strategies. CONCLUSION CBT was an effective treatment for diabetes patients, significantly reduced their HbA1c, FBS, DBP, depression and anxiety symptoms, and improved sleep quality.
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Affiliation(s)
- Yanni Li
- School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland Q422, Australia
| | - Eric A Storch
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX 77030, USA
| | - Samantha Ferguson
- School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland Q422, Australia
| | - Li Li
- Department of Endocrinology and Metabolism, Ningbo First Hospital, Ningbo, Zhejiang Province 315010, China
| | - Nicholas Buys
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland Q422, Australia
| | - Jing Sun
- School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland Q422, Australia; Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland Q422, Australia.
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Fiqri AM, Sjattar EL, Irwan AM. Cognitive Behavioral Therapy for self-care behaviors with type 2 diabetes mellitus patients: A systematic review. Diabetes Metab Syndr 2022; 16:102538. [PMID: 35753292 DOI: 10.1016/j.dsx.2022.102538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 06/02/2022] [Accepted: 06/04/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND AIMS Self-care behavior is associated with the risk of microvascular and macrovascular complications. Self-care behaviors can be improved through positive thinking, attitude, and knowledge. Cognitive behavioral therapy (CBT) can be one of the interventions for improving self-care behaviors. However, the ideal model and duration of the intervention and an effective assessment instrument to measure the improvement in self-care behaviors remain unidentified. Therefore, this review aimed to assess the effectiveness of CBT, including its models, duration, and instruments, in improving self-care behaviors in patients with type 2 diabetes mellitus (T2DM). METHODS The Scopus, Cochrane Library, PubMed, EBSCO Host, Directory of Open Access Journals, GARUDA, Taylor & Francis, and Gray Literature databases were systematically searched to identify studies that were in English and published in 2011-2021. The quality of the identified articles was assessed using The Critical Appraisal Skill Programme. RESULTS We found 368 patients in seven randomized controlled trials. CBT was significantly effective in improving overall self-care behavior, including blood glucose monitoring, physical activity, and medication compliance. CONCLUSION Individual and group CBT interventions applied face-to-face, via telephone, and via internet show an increase in self-care behavior in patients with T2DM. The duration of treatment had a significant effect at 3 months to 1 year with 12-21 sessions. CBT is performed by a CBT licensed nurse or psychiatrist, nutritionist, CBT psychologist with experience in diabetes care, doctors, research students.
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Affiliation(s)
- Andi Muhammad Fiqri
- Post Graduate Nursing Program, Faculty of Nursing, Hasanuddin University, Perintis Kemerdekaan Street KM.10, Tamalanrea, South-Sulawesi, Makassar, 90245, Indonesia
| | - Elly Lilianty Sjattar
- Medical Surgical Nursing Department, Faculty of Nursing, Hasanuddin University, Perintis Kemerdekaan Street KM.10, Tamalanrea, South-Sulawesi, Makassar, 90245, Indonesia
| | - Andi Masyitha Irwan
- Gerontological Nursing Department, Faculty of Nursing, Hasanuddin University, Perintis Kemerdekaan Street KM.10, Tamalanrea, South-Sulawesi, Makassar, 90245, Indonesia.
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Srisurapanont M, Suttajit S, Kosachunhanun N, Likhitsathian S, Suradom C, Maneeton B. Antidepressants for depressed patients with type 2 diabetes mellitus: A systematic review and network meta-analysis of short-term randomized controlled trials. Neurosci Biobehav Rev 2022; 139:104731. [PMID: 35691471 DOI: 10.1016/j.neubiorev.2022.104731] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 06/03/2022] [Accepted: 06/07/2022] [Indexed: 10/18/2022]
Abstract
This network meta-analysis compared the short-term treatment effects of different antidepressants on depression severity and HbA1c in depressed patients with type 2 diabetes mellitus (T2DM). We searched 8- to 24-week randomized-controlled trials (RCTs) in PubMed, Scopus, Web of Science, Cochrane Central Register of Controlled Trials, and Clinicaltrials.gov on November 22, 2021. We included 12 RCTs (N = 792) studying agomelatine, citalopram, escitalopram, fluoxetine, nortriptyline, no treatment, paroxetine, sertraline, vortioxetine, and placebo. Compared to placebo, the standardized mean differences and 95% confidence intervals (SMD, 95%CIs) for depression severity reduction revealed that escitalopram ranked first (-2.93, -3.92 to -1.94), followed by agomelatine (-0.68, -1.15 to -0.20). Compared to placebo, the mean differences (MDs, 95%CIs) for HbA1c reduction suggested that vortioxetine ranked first (-2.35, -4.13 to -0.57), followed by escitalopram (-1.00, -1.42 to -0.57) and agomelatine (-0.79, -1.16 to -0.42). Limited evidence from short-term trials in depressed patients with T2DM suggests that escitalopram and agomelatine may have a favorable profile in reducing depression and controlling glycemic goals, but more trials are required.
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Affiliation(s)
- Manit Srisurapanont
- Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Thailand.
| | - Sirijit Suttajit
- Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Thailand
| | | | | | - Chawisa Suradom
- Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Thailand
| | - Benchalak Maneeton
- Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Thailand
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Cornely RM, Subramanya V, Owen A, McGee RE, Kulshreshtha A. A mixed-methods approach to understanding the perspectives, experiences, and attitudes of a culturally tailored cognitive behavioral therapy/motivational interviewing intervention for African American patients with type 2 diabetes: a randomized parallel design pilot study. Pilot Feasibility Stud 2022; 8:107. [PMID: 35597972 PMCID: PMC9123732 DOI: 10.1186/s40814-022-01066-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 05/06/2022] [Indexed: 11/12/2022] Open
Abstract
Background African American (AA) adults are 60% more likely to be diagnosed with diabetes mellitus (DM) and experience more complications than non-Hispanic White adults. Cognitive behavioral therapy (CBT) has shown to be an effective modality for helping patients improve health behaviors and regulate emotional states. Motivational interviewing (MI) addresses participant engagement and motivation. Therefore, MI was combined with CBT as an approach to the process of learning using CBT skills to promote healthy lifestyle choices. We aimed to assess the effects of a culturally tailored CBT/MI intervention on glycemic control in AA participants and understand their perspectives, attitudes, and experiences while participating in this intervention. Methods Using a randomized, parallel design pilot study (web-based group vs in-person group), 20 participants aged ≥ 18 years, identifying as AA and having a glycosylated hemoglobin (HbA1c) > 8%, were recruited. A CBT/MI intervention was administered in six sessions over 3 months. Participants completed baseline and follow-up assessments on measures for diabetes control (HbA1c), self-efficacy, generalized anxiety, depression, perceived stress, health-related quality of life, and cognitive ability. Post-CBT/MI intervention focus groups were conducted to determine patient perspectives regarding the intervention. Results Fourteen participants completed the study, their mean HbA1c improved from 10.0 to 8.9% (t(26) = 0.5, p-value = 0.06). The Diabetes Distress Scale demonstrated decreased distress overall (t(26) = 2.6; p-value = 0.02). The Generalized Anxiety Disorder Scale demonstrated decreased generalized anxiety for all participants (t(26) = 2.2; p = 0.04). Themes identified in focus groups included (1) intervention group social support through information sharing, (2) mental health and personal identities in diabetes understanding and management, and (3) receptivity to CBT/MI intervention positively impacts self-efficacy through improved health literacy. Conclusion This group-based, culturally tailored CBT/MI intervention for type 2 DM care was positively received by AA participants and helped improve diabetes control, as demonstrated by the change in HbA1c. There were additional benefits of social support through group interactions and a stronger sense of self-efficacy due to health education. A comprehensive treatment plan using a CBT/MI intervention may be useful in promoting healthy diabetes self-management. Trial registration ClinicalTrials.gov, NCT03562767. Registered on 19 June 2018
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Affiliation(s)
- Ronald M Cornely
- Behavioral, Social, & Health Education Sciences Department, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Vinita Subramanya
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Ashley Owen
- Department of Family and Preventive Medicine, Emory University School of Medicine, 4500 North Shallowford Rd
- Suite 134, Atlanta, GA, 30338, USA
| | - Robin E McGee
- Behavioral, Social, & Health Education Sciences Department, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Ambar Kulshreshtha
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA. .,Department of Family and Preventive Medicine, Emory University School of Medicine, 4500 North Shallowford Rd
- Suite 134, Atlanta, GA, 30338, USA.
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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 2022; 36:108185. [PMID: 35367124 DOI: 10.1016/j.jdiacomp.2022.108185] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 03/22/2022] [Accepted: 03/22/2022] [Indexed: 02/07/2023]
Abstract
Cognitive Behavioral Therapy (CBT) has long been recognized as a type of psychotherapy for the management of glycemic control and comorbid psychological disorders and symptoms in adults with diabetes, and has been previously reported with varying outcomes. The aim of this scoping review is to evaluate the randomized controlled trials (RCTs) in order to determine the effects of CBT on Type 2 diabetes mellitus (T2DM) patients regarding depressive and anxiety symptoms, diabetes distress, and quality of life. An extensive literature search was conducted of the Pubmed, Scopus, Cinahl and Medline electronic databases. The search yielded 349 studies, of which 12 eventually met the entry requirements for RCTs. The majority of the studies included in the current scoping review demonstrated the benefits of CBT intervention in the amelioration of depressive symptoms, diabetes-related distress and quality of life in patients with T2DM. However, some studies reported limited evidence to support the use of CBT as an adjuvant therapy. The considerable levels of heterogeneity associated with most RCTs included warrant caution when interpreting results. The findings of this scoping review demonstrate the positive impact of CBT on depressive symptoms and other psychological aspects of everyday life in patients with T2DM.
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Affiliation(s)
- Eugenia Vlachou
- Department of Nursing, University of West Attica, Athens, Greece.
| | | | | | | | - Thodoris Chalimourdas
- 1st Department of Psychiatry, Eginition Hospital, Medical School-National and Kapodistrian University of Athens, Greece
| | - Omar Cauli
- Frailty and Cognitive Impairment Group (FROG), University of Valencia, 46010 Valencia, Spain; Department of Nursing, University of Valencia, 46010 Valencia, Spain.
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Mishra KK, Sawant N, Garg S. Management of Psychiatric Disorders in Patients with Endocrine Disorders. Indian J Psychiatry 2022; 64:S402-S413. [PMID: 35602375 PMCID: PMC9122171 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_30_22] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 01/06/2022] [Accepted: 01/07/2022] [Indexed: 11/06/2022] Open
Abstract
The neuropsychiatric symptoms and disorders among endocrine disorders are discussed in the context of current global and local epidemiological data. Neuropsychiatric symptoms, clinical differentials in hypothyroidism, hyperthyroidism, and parathyroid disorders, and relevant management protocols are described. HPT axis and its interaction with psychotropic usage are mentioned. Stress diathesis, depression, anxiety disorders, and severe mental illnesses and their respective association with diabetes, the relevant mechanisms, and management protocols are stated. The metabolic syndrome, its definition, and its relationship to psychotropic usage are laid out. Moreso, best clinical practices for scenarios such as hyperprolactinemia and psychiatric illnesses, and steroid-induced psychosis are mentioned.
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Affiliation(s)
- Kshirod Kumar Mishra
- Department of Psychiatry, Mahatma Gandhi Institute of Medical Sciences, Sevagram, Maharashtra, India
| | - Neena Sawant
- Department of Psychiatry, Seth GSMC and KEM Hospital, Mumbai, Maharashtra, India
| | - Shobit Garg
- Department of Psychiatry, Shri Guru Ram Rai Institute of Medical and Health Sciences, Dehradun, Uttarakhand, India
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Oyedeji AD, Ullah I, Weich S, Bentall R, Booth A. Effectiveness of non-specialist delivered psychological interventions on glycemic control and mental health problems in individuals with type 2 diabetes: a systematic review and meta-analysis. Int J Ment Health Syst 2022; 16:9. [PMID: 35120528 PMCID: PMC8817494 DOI: 10.1186/s13033-022-00521-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 01/13/2022] [Indexed: 11/15/2022] Open
Abstract
Background Typically, specialist mental health professionals deliver psychological interventions for individuals with poorly controlled type 2 diabetes mellitus (T2DM) and related mental health problems. However, such interventions are not generalizable to low- and middle-income countries, due to the dearth of trained mental health professionals. Individuals with little or no experience in the field of mental health (referred to as non-specialists) may have an important role to play in bridging this treatment gap. Aim To synthesise evidence for the effectiveness of non-specialist delivered psychological interventions on glycaemic control and mental health problems in people with T2DM. Methods Eight databases and reference lists of previous reviews were systematically searched for randomized controlled trials (RCTs). Outcome measures were glycated hemoglobin (HbA1c), diabetes distress and depression. The Cochrane Collaboration Risk of Bias Tool was used for risk of bias assessment. Data from the included studies were synthesized using narrative synthesis and random effects meta-analysis. Results 16 RCTs were eligible for inclusion in the systematic review. The 11 studies that were pooled in the meta-analysis demonstrated a reduction in HbA1c in favor of non-specialist delivered psychological interventions when compared with control groups (pooled mean difference = − 0.13; 95% CI − 0.22 to − 0.04, p = 0.005) with high heterogeneity across studies (I2 = 71%, p = 0.0002). The beneficial effects of the interventions on diabetes distress and depression were not consistent across the different trials. Conclusion Non-specialist delivered psychological interventions may be effective in improving HbA1c. These interventions have some promising benefits on diabetes distress and depression, although the findings are inconclusive. More studies of non-specialist delivered psychological interventions are needed in low- and middle-income countries to provide more evidence of the potential effectiveness of these interventions for individuals living with T2DM.
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Affiliation(s)
- Ayodeji D Oyedeji
- School of Health and Related Research, University of Sheffield, Sheffield, S1 4DA, UK.
| | - Ibrahim Ullah
- Centre for Assistive Technology and Connected Healthcare, School of Health and Related Research, University of Sheffield, Sheffield, S1 4DA, UK
| | - Scott Weich
- School of Health and Related Research, University of Sheffield, Sheffield, S1 4DA, UK
| | - Richard Bentall
- Department of Psychology, University of Sheffield, Sheffield, S1 4DA, UK
| | - Andrew Booth
- School of Health and Related Research, University of Sheffield, Sheffield, S1 4DA, UK
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Sakamoto R, Ohtake Y, Kataoka Y, Matsuda Y, Hata T, Otonari J, Yamane A, Matsuoka H, Yoshiuchi K. Efficacy of acceptance and commitment therapy for people with type 2 diabetes: Systematic review and meta-analysis. J Diabetes Investig 2022; 13:262-270. [PMID: 34486816 PMCID: PMC8847115 DOI: 10.1111/jdi.13658] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 08/24/2021] [Accepted: 09/01/2021] [Indexed: 12/11/2022] Open
Abstract
AIMS/INTRODUCTION This systematic review and meta-analysis aimed to investigate the efficacy and safety of acceptance and commitment therapy (ACT) for people with type 2 diabetes mellitus. MATERIALS AND METHODS Several electronic databases were examined on 16 January 2021, including PubMed, CENTRAL, PsycINFO, International Clinical Trials Registry Platform and ClinicalTrials.gov. Randomized controlled trials were included to compare ACT with usual treatment for people with type 2 diabetes reported in any language. Primary outcome measures were glycated hemoglobin, self-care ability assessed by the summary of diabetes self-care activities and all adverse events. The secondary outcome measure was acceptance assessed by the acceptance and action diabetes questionnaire. RESULTS Of 678 publications initially identified, three trials were included in the meta-analysis. ACT resulted in a reduction in glycated hemoglobin (mean difference -0.62 points lower in the intervention group; 95% confidence interval -1.07 to -0.16; I2 = 0%; low-quality evidence). In addition, ACT increased the score of the summary of diabetes self-care activities (mean difference 8.48 points higher in the intervention group; 95% confidence interval 2.16-14.80; high-quality evidence). Adverse events were not measured in all trials. ACT increased scores of the acceptance and action diabetes questionnaire (mean difference 5.98 points higher in the intervention group; 95% confidence interval, 1.42-10.54; I2 = 43%; low-quality evidence). CONCLUSIONS ACT might reduce glycated hemoglobin, and increase self-care ability and acceptance among people with type 2 diabetes.
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Affiliation(s)
- Ryo Sakamoto
- Department of Psychosomatic MedicineFaculty of MedicineKindai UniversityOsakasayamaJapan
| | - Yoichi Ohtake
- Department of Internal MedicineItami Seifu HoupitalItamiJapan
- Department of Psychosomatic Internal Medicine a Palliative Care MedicineSakai City Medical CenterSakaiJapan
| | - Yuki Kataoka
- Department of Internal MedicineKyoto Min‐Iren Asukai HospitalKyotoJapan
- Systematic Review Workshop Peer Support Group (SRWS‐PSG)OsakaJapan
- Section of Clinical EpidemiologyDepartment of Community MedicineKyoto University Graduate School of MedicineKyotoJapan
- Department of Healthcare EpidemiologyGraduate School of Medicine and Public HealthKyoto UniversityKyotoJapan
| | - Yoshinobu Matsuda
- Department of Psychosomatic Internal MedicineNational Hospital Organisation Kinki‐Chuo Chest Medical CenterSakaiJapan
| | - Tomokazu Hata
- Department of Psychosomatic MedicineGraduate School of Medical SciencesKyushu UniversityFukuokaJapan
| | - Jun Otonari
- Department of Psychosomatic MedicineInternational University of Health and Welfare Narita HospitalChibaJapan
| | - Akira Yamane
- Department of Psychosomatic MedicineKansai Medical University HospitalHirakataJapan
| | | | - Kazuhiro Yoshiuchi
- Department of Stress Sciences and Psychosomatic MedicineGraduate School of MedicineThe University of TokyoTokyoJapan
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Mansour N, Labib N, Khalil M, Esmat S. Brief Cognitive Behavioral Therapy for Patients with Comorbid Depression and Type 2 Diabetes in an Urban Primary Care Facility: Randomized Controlled Trial. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.7883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background: The relation between depression and diabetes is bidirectional and both can lead to morbidity and mortality. Despite the success of Cognitive Behavioral Therapy (CBT) in managing psychiatric comorbidities, research on its use in the treatment of comorbid diabetes and depression is limited and with varying results. The aim of the study is to assess the efficacy of CBT on depressed patients with type 2 diabetes.
Methods: This randomized controlled trial was conducted at an urban primary healthcare center in Egypt from February 2019 to March 2020 and included 80 participants. Key inclusion criteria were uncontrolled type 2 diabetes (T2D) (HbA1c >7.5%) and depression symptoms diagnosed by Beck’s Depression Index. Participants were assessed for all battery of instruments. Subsequently, participants were randomized to control and treatment groups. The treatment group received four CBT sessions. Both groups received a thirty-minute structured diabetes education and their usual diabetes treatment. Three months later, all participants were reassessed for depression and diabetes compliance and all labs were performed post intervention. Both the primary (the difference in HbA1c pre-post intervention) and secondary outcomes (the change in depressive symptoms assessed) were analyzed using ANCOVA.
Results: Both groups were matching at baseline. Post intervention, the CBT group revealed a significant reduction in depressive symptoms while adjusting for Beck Depression Index (BDI) pre-intervention [F (1, 74) = 7.074, p = 0.010]. Moreover, HBA1c was improved significantly when controlling for pre-intervention BDI scores and BMI [F (1,73) = 4.27, p = 0.042] compared to the control group.
Conclusions: The CBT program was both inexpensive and easily accessible. It could fit very well in primary care settings. The results indicated CBT intervention was effective in improving diabetes control and depression. However, a larger-scale study to test its effect on a larger scale population and its long-term impact is recommended.
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Patton SR, Monzon AD, Marker AM, Clements MA. A Nonrandomized Pilot of a Group Video-Based Telehealth Intervention to Reduce Diabetes Distress in Parents of Youth with Type 1 Diabetes Mellitus. Can J Diabetes 2021; 46:262-268. [PMID: 35568427 PMCID: PMC9107594 DOI: 10.1016/j.jcjd.2021.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 09/13/2021] [Accepted: 10/24/2021] [Indexed: 01/09/2023]
Abstract
OBJECTIVES Our aim in this study was to refine and pilot a video-based telehealth intervention to reduce diabetes distress, depressive symptoms and hypoglycemia fear in parents of school-age children with type 1 diabetes and to assess for changes in child glycated hemoglobin (A1C). METHODS We recruited 41 parents of children (5 to 12 years) to participate in a manualized, video-based telehealth intervention (Cognitive Adaptions to Reduce Emotional Stress [CARES]). Of these, 29 parents completed either a 12-week (n=13) or 8-week (n=16) version of CARES based on the timing of their recruitment. We assessed feasibility (i.e. attrition, attendance) and parent satisfaction with CARES. We used repeated-measures analysis of variance with parent group (8 vs 12 sessions) as a between-subject variable and time as a within-subject variable to measure change in our dependent variables. RESULTS Mostly mothers participated (97.3%). Parents' mean age was 39.65±6.84 years and children's mean age was 9.86±1.57 years at pretreatment. CARES had low attrition (20% to 25%) and good attendance (96% to 98%). Parents also reported high levels of treatment satisfaction (>85%). There were significant main effects for time for parent-reported diabetes distress and depressive symptoms at posttreatment and 3-month follow-up. There was a statistical trend suggesting a time × group interaction for parent depressive symptoms at posttreatment. There was a significant main effect for time for hypoglycemia fear at the 3-month follow-up but no change at posttreatment. There was no change in child A1C at posttreatment. CONCLUSION CARES showed high parent satisfaction, good feasibility and promising results for reducing diabetes distress in parents of school-age children with type 1 diabetes.
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Clever SN, Baulig S, Benecke A. Psychologische Herausforderungen bei Erwachsenen mit Typ-1-Diabetes. DIABETOL STOFFWECHS 2021. [DOI: 10.1055/a-1338-4332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
ZusammenfassungMenschen mit Typ-1-Diabetes müssen immer wieder verschiedene Anpassungsleistungen erbringen, um ihre Erkrankung und deren Therapie in den Alltag integrieren zu können. Gelingt dies nicht, können daraus Probleme beim Selbstmanagement der Krankheit resultieren. Doch trotz strukturierter Schulungsprogramme und leitliniengerechter, individuell zugeschnittener Therapieempfehlungen leben einige Menschen mit Typ-1-Diabetes mit chronisch erhöhten Blutzuckerwerten. Dabei scheint der Diabetes-Distress als Reaktion auf die erlebten Herausforderungen eine wichtige Rolle zu spielen und im Zusammenhang mit Problemen bei der glykämischen Kontrolle wie auch einer Therapievermeidung zu stehen. Um eine Chronifizierung des Diabetes-Distress zu verhindern, empfiehlt es sich daher, ein Screening auf diabetesbezogene Belastungen in der Versorgung von Menschen mit Typ-1-Diabetes zu etablieren. Dies kann mittels Fragebogen oder der Thematisierung im persönlichen Gespräch geschehen. Diabetesspezifische psychologische Interventionen können sowohl die diabetesbezogene emotionale Belastung als auch die glykämische Kontrolle verbessern, sind jedoch in Deutschland noch nicht in der Regelversorgung verfügbar.
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Affiliation(s)
- Susan Norah Clever
- Psychotherapiepraxis, Diabetespraxis Blankenese, Hamburg, Germany
- CEO, Medical Psychology Consultancy, Hamburg, Germany
| | - Susanne Baulig
- Poliklinische Institutsambulanz für Psychotherapie, Johannes-Gutenberg-Universität Mainz, Germany
| | - Andrea Benecke
- Poliklinische Institutsambulanz für Psychotherapie, Johannes-Gutenberg-Universität Mainz, Germany
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Winkley K, Upsher R, Stahl D, Pollard D, Kasera A, Brennan A, Heller S, Ismail K. Psychological interventions to improve self-management of type 1 and type 2 diabetes: a systematic review. Health Technol Assess 2021; 24:1-232. [PMID: 32568666 DOI: 10.3310/hta24280] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND For people with diabetes mellitus to achieve optimal glycaemic control, motivation to perform self-management is important. The research team wanted to determine whether or not psychological interventions are clinically effective and cost-effective in increasing self-management and improving glycaemic control. OBJECTIVES The first objective was to determine the clinical effectiveness of psychological interventions for people with type 1 diabetes mellitus and people with type 2 diabetes mellitus so that they have improved (1) glycated haemoglobin levels, (2) diabetes self-management and (3) quality of life, and fewer depressive symptoms. The second objective was to determine the cost-effectiveness of psychological interventions. DATA SOURCES The following databases were accessed (searches took place between 2003 and 2016): MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Library, PsycINFO, EMBASE, Cochrane Controlled Trials Register, Web of Science, and Dissertation Abstracts International. Diabetes conference abstracts, reference lists of included studies and Clinicaltrials.gov trial registry were also searched. REVIEW METHODS Systematic review, aggregate meta-analysis, network meta-analysis, individual patient data meta-analysis and cost-effectiveness modelling were all used. Risk of bias of randomised and non-randomised controlled trials was assessed using the Cochrane Handbook (Higgins JP, Altman DG, Gøtzsche PC, Jüni P, Moher D, Oxman AD, et al. The Cochrane Collaboration's tool for assessing risk of bias in randomised trials. BMJ 2011;343:d5928). DESIGN Systematic review, meta-analysis, cost-effectiveness analysis and patient and public consultation were all used. SETTING Settings in primary or secondary care were included. PARTICIPANTS Adolescents and children with type 1 diabetes mellitus and adults with types 1 and 2 diabetes mellitus were included. INTERVENTIONS The interventions used were psychological treatments, including and not restricted to cognitive-behavioural therapy, counselling, family therapy and psychotherapy. MAIN OUTCOME MEASURES Glycated haemoglobin levels, self-management behaviours, body mass index, blood pressure levels, depressive symptoms and quality of life were all used as outcome measures. RESULTS A total of 96 studies were included in the systematic review (n = 18,659 participants). In random-effects meta-analysis, data on glycated haemoglobin levels were available for seven studies conducted in adults with type 1 diabetes mellitus (n = 851 participants) that demonstrated a pooled mean difference of -0.13 (95% confidence interval -0.33 to 0.07), a non-significant decrease in favour of psychological treatment; 18 studies conducted in adolescents/children with type 1 diabetes mellitus (n = 2583 participants) that demonstrated a pooled mean difference of 0.00 (95% confidence interval -0.18 to 0.18), indicating no change; and 49 studies conducted in adults with type 2 diabetes mellitus (n = 12,009 participants) that demonstrated a pooled mean difference of -0.21 (95% confidence interval -0.31 to -0.10), equivalent to reduction in glycated haemoglobin levels of -0.33% or ≈3.5 mmol/mol. For type 2 diabetes mellitus, there was evidence that psychological interventions improved dietary behaviour and quality of life but not blood pressure, body mass index or depressive symptoms. The results of the network meta-analysis, which considers direct and indirect effects of multiple treatment comparisons, suggest that, for adults with type 1 diabetes mellitus (7 studies; 968 participants), attention control and cognitive-behavioural therapy are clinically effective and cognitive-behavioural therapy is cost-effective. For adults with type 2 diabetes mellitus (49 studies; 12,409 participants), cognitive-behavioural therapy and counselling are effective and cognitive-behavioural therapy is potentially cost-effective. The results of the individual patient data meta-analysis for adolescents/children with type 1 diabetes mellitus (9 studies; 1392 participants) suggest that there were main effects for age and diabetes duration. For adults with type 2 diabetes mellitus (19 studies; 3639 participants), baseline glycated haemoglobin levels moderated treatment outcome. LIMITATIONS Aggregate meta-analysis was limited to glycaemic control for type 1 diabetes mellitus. It was not possible to model cost-effectiveness for adolescents/children with type 1 diabetes mellitus and modelling for type 2 diabetes mellitus involved substantial uncertainty. The individual patient data meta-analysis included only 40-50% of studies. CONCLUSIONS This review suggests that psychological treatments offer minimal clinical benefit in improving glycated haemoglobin levels for adults with type 2 diabetes mellitus. However, there was no evidence of benefit compared with control interventions in improving glycated haemoglobin levels for people with type 1 diabetes mellitus. FUTURE WORK Future work should consider the competency of the interventionists delivering a therapy and psychological approaches that are matched to a person and their life course. STUDY REGISTRATION This study is registered as PROSPERO CRD42016033619. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 28. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Kirsty Winkley
- Florence Nightingale Faculty of Nursing and Midwifery, King's College London, London, UK
| | - Rebecca Upsher
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Daniel Stahl
- Department of Biostatistics, Institute of Psychiatry, King's College London, London, UK
| | - Daniel Pollard
- Health Economics and Decision Science, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Architaa Kasera
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Alan Brennan
- Health Economics and Decision Science, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Simon Heller
- Academic Unit of Diabetes, Endocrinology and Metabolism, Department of Oncology & Metabolism, University of Sheffield, Sheffield, UK
| | - Khalida Ismail
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Merlo G, Vela A. Applying Psychiatry and Psychology Principles to Lifestyle Approaches for Mental and Behavioral Health. Am J Lifestyle Med 2021; 16:723-733. [DOI: 10.1177/15598276211023415] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 05/03/2021] [Accepted: 05/20/2021] [Indexed: 11/16/2022] Open
Abstract
Research suggests that mental health symptoms and disorders are historically underdiagnosed and undertreated, in part due to the siloed nature of medicine. Yet, approximately 50 million American adults experience a mental health disorder. As the field of lifestyle medicine continues to emerge and grow, there is an important opportunity to address mental health from a lifestyle medicine perspective, as well as to ensure that lifestyle medicine can be utilized for all patients, including those with mental health conditions. To effectively address mental health, the field of lifestyle medicine would benefit from understanding and leveraging the decades of science and practice from the fields of psychiatry and psychology, as well as the expertise of psychiatrists and psychologists who are familiar with the science and trained in lifestyle medicine. Incorporating empirical literature from other areas, utilizing well-established conceptual frameworks, and addressing the overlap between lifestyle medicine and mental health early in, and throughout, training and education, are important steps to move toward addressing mental and behavioral health with a lifestyle medicine approach.
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Affiliation(s)
- Gia Merlo
- Rory Meyers College of Nursing, NYU Grossman School of Medicine, New York University, New York, New York
| | - Alyssa Vela
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
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