Systematic Review of Psychological and Educational Interventions Used to Improving Adherence in Diabetes and Depression Patients

Abstract

Diabetes is a life-long chronic condition that is an established risk factor for the development of comorbid depression and possibly affecting medication adherence. Psychological and educational interventions are reported efficacious by the National Institute for Health and Care Excellence (NICE) in treating depression associated with a comorbid condition. As depression is associated with low adherence rates to treatment regimens, improving depression outcomes could improve adherence and therefore glycaemic control. A search strategy was conducted on search engines Google Scholar, PubMed, and Cochrane library for clinical trials. A total of 10 Randomised controlled trials (RCTs) were identified which investigated the effects of psychological and educational interventions on Type 2 diabetic patients with comorbid depression. Outcomes measured were depression and glycaemic control. Evidence from the 10 RCTs with 5759 participants suggests that psychological and educational intervention improved depression outcomes substantially and glycaemic control to an extent. Depression outcomes results were significant: standard mean deviation (SMD) was -0.39 (95% CI -0.62, -0.15); I-2 = 81%) p<0.001. Diabetes outcomes were not seen to be significant, SMD was -0.14 (95% CI -0.32, 0.03); I-2 = 44%) p=0.12. Psychological and educational interventions are effective in improving depression symptoms significantly and may assist in glycaemic control. Further research is required using larger sample sizes that could be generalized and representative of the whole population.