Interventions to reduce diabetes-related distress among adults with type 1 or type 2 diabetes: a systematic review and meta-analysis of randomised controlled trials

Why clinicians should know about it

• Picked for Internal Medicine (top studies of the week, 13 September 2026): Systematic review of RCTs reducing diabetes distress
• Picked for Family Practice (top studies of the week, 13 September 2026): Duplicate entry, already evaluated

Abstract

AIMS/HYPOTHESIS: Diabetes distress refers to the emotional and psychological burden specifically associated with living with and managing diabetes. We aimed to systematically identify, summarise and critically appraise the available evidence from RCTs assessing the efficacy of interventions for reducing diabetes distress among adults with type 1 or type 2 diabetes. METHODS: We searched PubMed, the Cochrane Library, APA PsycInfo and CINAHL from inception until 23 September 2024. Studies were eligible if they were RCTs conducted in adults (aged ≥18 years) with type 1 or type 2 diabetes in which the effect of an active intervention on diabetes distress was recorded as a primary or a secondary outcome. Studies with combined populations (e.g. children plus adults) where no separate results were reported for adults were excluded. When possible, we performed a random-effects meta-analysis of the standardised mean difference (SMD) of the endpoint, diabetes distress, measured with a validated questionnaire. We conducted subgroup analyses based on baseline diabetes distress level, intervention delivery method, risk of bias assessment (using the Cochrane RoB2 tool) and trial duration. We used GRADE methodology to assess the certainty of evidence. RESULTS: We included 248 trials, with 59 trials reporting on psychological interventions, 68 on psychoeducational interventions and 121 on miscellaneous interventions (non-psychological or non-psychoeducational, i.e. education without a psychological component, peer support without a psychological component, devices, telehealth, health behaviours and a heterogeneous group of other interventions). In total, 52 trials included participants with type 1 diabetes (including two during pregnancy), 160 included participants with type 2 diabetes, and 36 included mixed/undefined populations of adults with diabetes. The total sample size was 55,497 participants (range 12-4034). The analysed trials were judged to have either some concerns for risk of bias (94 trials) or a high risk of bias (71 trials). Compared with usual care, psychological interventions reduced diabetes distress in adults with type 1 diabetes (SMD -0.22 [95% CI -0.35, -0.08]; N=16; GRADE = low) and type 2 diabetes (SMD -0.31 [95% CI -0.50, -0.13]; N=21; GRADE = very low). Additionally, continuous glucose monitoring (CGM) or intermittently scanned glucose monitoring reduced diabetes distress in adults with type 1 diabetes, compared with standard blood glucose measurement (SMD -0.26 [95% CI -0.41, -0.11]; N=6; GRADE = moderate), while educational interventions reduced diabetes distress in adults with type 2 diabetes, compared with usual care (SMD -0.34 [95% CI -0.56, -0.11]; N=3; GRADE = low). Other comparisons, including those of psychological, psychoeducational, peer support, educational and device-based interventions with various active control interventions or usual care, did not show statistically significant effects. The results did not differ meaningfully across predefined subgroups. The certainty of evidence as assessed by GRADE methodology was moderate, low or very low in two, five and seven comparisons, respectively. No meta-analyses could be conducted for telehealth, health behaviours and the assorted mixed interventions due to heterogeneity or an insufficient number of studies. CONCLUSIONS/INTERPRETATION: Psychological interventions reduced diabetes distress among adults with type 1 diabetes and those with type 2 diabetes, while devices reduced diabetes distress in adults with type 1 diabetes and education reduced diabetes distress in adults with type 2 diabetes. Most other interventions showed little or no clear effect. FUNDING: European Association for the Study of Diabetes. REGISTRATION: PROSPERO registration no. CRD42024598512.

Abstract as published, via PubMed.