Efficacy of cognitive behavioural therapy in type 2 diabetes initiating insulin therapy for the first time

Abstract

To measure the impact of cognitive behaviour therapy (CBT) on blood glucose regulation, negative emotional states, and medication adherence in type 2 diabetes mellitus (T2DM) patients initiating insulin therapy. Patients diagnosed with T2DM, hospitalised in the Department of Endocrinology from January 2022 to June 2023 and scheduled to commence long-term insulin therapy, were randomised into a control group that received standard insulin therapy and a combined treatment group that received additional CBT (n = 50). Parameters such as fasting blood glucose (FBG), 2-hour postprandial blood glucose (PBG), glycosylated haemoglobin (HbA1c), and fasting C-peptide (F-CP) levels were monitored before and after the intervention. Assessment of changes in anxiety, depression, and medication adherence was achieved via the hospital anxiety and depression scale (HADS) and the 5-item version of medication adherence report scale (MARS-5I). Among 95 patients, 48 were included in the control group and 47 in the combined treatment group, with both demonstrating remarkably improved FBG, PBG and HbA1c (P < 0.05); however, the enhancements were more significant in the combined treatment group (P < 0.05). F-CP levels did not show an obvious variation in either group (P > 0.05). The combined treatment group presented lower HADS scores post-intervention (P < 0.05), and both the individual and total scores of MARS-5I increased (P < 0.05). Comparatively, the control group exhibited no obvious improvement in HADS scores (P > 0.05). However, the score for item 1 of the MARS-5I improved (P < 0.05); other individual scores and the total score showed no improvement (P > 0.05). CBT, when combined with conventional therapy, effectively enhances blood glucose control and improves anxiety, depression scores, and medication adherence among T2DM patients beginning insulin therapy for the first time.