Interventions to reduce diabetes-related distress among adults with type 1 and type 2 diabetes: protocol for a systematic review and meta-analysis

Abstract

Diabetes distress (DD) refers to the emotional and psychological burden experienced by individuals living with diabetes. Randomized controlled trials (RCTs) have investigated the efficacy of interventions on DD among adults with type 1 diabetes or type 2 diabetes. We aimed to systematically identify, summarize and critically appraise all available evidence from RCTs assessing the efficacy of interventions for reducing DD (either as primary or secondary outcome) among adults with type 1 diabetes or type 2 diabetes. Four electronic databases (PubMed, Cochrane Database of Systematic Reviews, PsycINFO and CINAHL) were searched from inception until 23 September 2024. Retrieved papers were screened for eligibility by two independent reviewers, who also screened the reference lists of all included publications. Studies were included if the study was an RCT performed in an adult population (≥18 years), in which the efficacy of an active intervention on DD as primary or secondary outcome was described. Data were extracted using an a priori developed form. Two independent reviewers assessed the risk of bias of included studies using the Cochrane RoB 2 tool for RCTs. For each type of intervention, a narrative data synthesis was conducted, and, if possible, meta-analyses were conducted when two or more studies reported on the same outcome. Heterogeneity between studies was assessed using the I 2 statistic and a certainty of evidence assessment (GRADE) was conducted. In case of substantial heterogeneity, subgroup analysis was conducted. Data regarding the efficacy of interventions on DD was summarized and discussed. Future implications and recommendations for clinical care were presented. This systematic review and meta-analysis served as the basis for a European Association for the Study of Diabetes (EASD) guideline on the management of DD. PROSPERO CRD42024598512.