Effectiveness of Cognitive Behavioral Therapy on Quality of Life of Patients with Diabetes in Iran: a systematic review and meta-analysis

Diabetes is the most common disease caused by metabolic disorders. Diabetes disrupts the regular flow of life and affects individuals’ Quality of Life in various dimensions. Some interventions based on cognitive behavioral therapy  have been used to improve the QoL of patients with diabetes. This study aimed to systematically review the effect of cognitive behavioral therapy (CBT) in terms of improving the QoL of diabetic patients in Iran.

External (Google Scholar, PubMed, Scopus, Web of Science) and internal (SID, Magiran) databases were searched from the inception to February 2023. Cognitive behavioral interventions were compared with pre-test and post-test design and usual care control group or other psychosocial interventions. The standardized mean difference effect was calculated using a random effects model with 95% confidence. The risk of bias was assessed according to Cochrane(Rob). Data was analyzed using RewMan-5 software.

A total of 14 studies involving 444 diabetes patients were included in this study. At the first stage of the search, 504 articles were obtained. After reviewing the title and abstract of the articles, 465 articles were excluded due to being irrelevant and repetitive and 39 articles remained. Finally, 14 studies were selected by reviewing the abstracts of the articles and considering the inclusion criteria. Compared to the control group, the standardized mean difference for the effect of CBT on QoL in posttest was high (SMD = 1.06, 95% CI = [0.63, 1.48]) was obtained; The standard mean difference for the effect of CBT on quality of life in the follow-up phase was also moderate and equal to(SMD = 0.66, 95% CI = [0.34, 0.98]). The heterogeneity between the results of the studies was high (76%). Most of the studies had an unclear risk of bias. Despite publication bias, only one study had a high error and less accuracy than the rest of the studies.

This study shows promising results regarding the effects of psychological interventions on QoL, especially on CBT-based interventions. Screening patients with diabetes for mental health comorbidities and referring to a mental health specialist in the context of a multidisciplinary approach should be a priority.