Lack of evidence on whether cognitive behavioural therapy can improve glycaemic control

When we are looking to change our behaviour, we often turn to cognitive behavioural therapy, or CBT.  It has been proven effective in a number of settings, such as the management of pain or treatment of depression or schizophrenia.

Could CBT help people with diabetes to improve their health?

Clinical question:

In people with diabetes, does CBT improve glycaemic control?

The evidence:

The reviewer found eight studies for review, including six randomised trials.

When she combined the results of these studies, she found

no overall statistically significant impact on glycaemic control.

More research, which is more clearly focused and higher quality, is needed to identify possible benefits.  More details are needed about the target population and the form of the CBT intervention.

Appraisal hints:

  • The literature search may not have been thorough enough to identify all of the relevant studies.
  • As the reviewer included both type 1 and type 2 diabetes, it seems almost certain that there were too many differences between the studies to warrant meta-analysis.
  • What was the quality of the individual trials?  Were they sufficiently powered to address the clinical question?


Elliott S. Cognitive behavioural therapy and glycaemic control in diabetes mellitus. Practical Diabetes 2012; 29(2): 67-71

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I am an information scientist with an interest in making knowledge from systematic research more accessible to people who need it. This means you. I've been attempting this in the area of Evidence-Based Health Care since 1995. So far the results have been mixed. For some reason we expected busy clinicians to search databases and appraise papers instead of seeing patients. We also expected publishers to make the research freely available to the people who paid for it.. Ha! Hence The National Elf service.

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