Part 1. Impact on Management of Patients with Diabetes Mellitus (continued)

Discussion

This assessment identified 61 randomized controlled trials of behavioral therapies for the treatment of apparently typical patients with diabetes mellitus. Forty-eight of these trials compared behavioral therapies to non-behavioral control groups. The preponderance of evidence supports the contention that behavioral therapies tend to be modestly effective. Overall, the mean absolute effect on glycemic control at post-treatment (less than or equal to 3 months after completion of intervention) of such behavioral therapies is on the order of an absolute decrease in HbA1c of 0.62 percent (e.g., from 10 percent to 9.38 percent). At followup (greater than 3 months after completion of intervention), the mean absolute effect is on the order of a decrease in HbA1c of 0.47 percent (e.g., from 10 percent to 9.53 percent).

Among the types of interventions, cognitive-behavioral and behavioral diet/exercise interventions appear more effective than relaxation or blood glucose awareness therapy. Evidence for the two latter approaches is especially limited; what is available does not suggest a trend towards efficacy compared to control. Although not conclusive, it appears that therapies that affect weight loss tend to be more successful in improving glycemic control.

Of note, intensity of therapy in terms of numbers of sessions does not seem to relate to effectiveness. Specifically, more than 14 sessions does not appear to impart a greater clinical benefit than regimens of lesser intensity. Though it was not possible to sort out the possible benefit in the long-term of more sessions, it is plausible that more intensive therapy may provide more long-lasting benefits.

Studies not including a non-behavioral control were analyzed qualitatively, and the results were in concordance with the overall conclusions regarding the effectiveness of type and intensity of treatments.

Finally, we did not discern patterns in the available trials that would suggest that other patient, provider, or intervention characteristics influence the effectiveness of behavioral therapies.

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