How effective are CBT and CBT-based interventions in Type 1 and Type 2 diabetes? An umbrella review

Hanna Press; Leeanne Nicklas

doi:10.1111/dme.70271

How effective are CBT and CBT-based interventions in Type 1 and Type 2 diabetes? An umbrella review

Hanna Press (Lead / Corresponding author)
, Leeanne Nicklas (Lead / Corresponding author)

Postgraduate Medicine

Research output: Contribution to journal › Article › peer-review

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Abstract

Aims
Significant evidence base supports cognitive behavioural therapy (CBT) for diabetes. Large variations in practice make it difficult to assess the impact of different types of delivery. This umbrella review aimed to synthesise evidence on the effectiveness of CBT and CBT-based interventions for diabetes-related distress, comorbid depressive symptoms, anxiety symptoms and HbA1c levels. A secondary aim investigated whether effectiveness differs in CBT delivered by a CBT therapist compared to CBT-based interventions that are delivered by multidisciplinary staff.

Methods
Databases like CINAHL, MEDLINE, PsychINFO, PsychArticles and Cochrane Library were searched for systematic reviews and meta-analyses between 2014 and 2023. Review quality was assessed using the Scottish Intercollegiate Guidelines Network checklist. For the secondary aim, findings of randomised controlled trials were distinguished within reviews.

Results
Eleven systematic reviews and meta-analyses were included. Four of the reviews were rated as ‘high’-quality reviews, five as ‘acceptable’ and two as ‘low’-quality reviews. CBT-based interventions delivered by multidisciplinary staff significantly reduced depressive symptoms, diabetes-related distress and HbA1c levels. CBT therapy delivered by CBT therapists was associated with significant reductions in diabetes-related distress, anxiety symptoms, depressive symptoms and HbA1c levels.

Conclusions
CBT and CBT-based interventions were similarly effective for depressive symptoms and HbA1c levels. Anxiety symptoms only improved following CBT delivered by CBT therapists, while diabetes-related distress reduced more than for CBT-based interventions. Significant heterogeneity and variation in quality in reviews mean that further research is required.

Original language	English
Article number	e70271
Number of pages	14
Journal	Diabetic Medicine
Early online date	20 Feb 2026
DOIs	https://doi.org/10.1111/dme.70271
Publication status	E-pub ahead of print - 20 Feb 2026

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Keywords

anxiety
cognitive behavioural therapy
depression
diabetes mellitus
psychological distress
review

ASJC Scopus subject areas

Internal Medicine
Endocrinology, Diabetes and Metabolism
Endocrinology

Access to Document

10.1111/dme.70271Licence: CC BY

Final Published VersionFinal published version, 317 KBLicence: CC BY

Cite this

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title = "How effective are CBT and CBT-based interventions in Type 1 and Type 2 diabetes? An umbrella review",

abstract = "Aims Significant evidence base supports cognitive behavioural therapy (CBT) for diabetes. Large variations in practice make it difficult to assess the impact of different types of delivery. This umbrella review aimed to synthesise evidence on the effectiveness of CBT and CBT-based interventions for diabetes-related distress, comorbid depressive symptoms, anxiety symptoms and HbA1c levels. A secondary aim investigated whether effectiveness differs in CBT delivered by a CBT therapist compared to CBT-based interventions that are delivered by multidisciplinary staff. Methods Databases like CINAHL, MEDLINE, PsychINFO, PsychArticles and Cochrane Library were searched for systematic reviews and meta-analyses between 2014 and 2023. Review quality was assessed using the Scottish Intercollegiate Guidelines Network checklist. For the secondary aim, findings of randomised controlled trials were distinguished within reviews. Results Eleven systematic reviews and meta-analyses were included. Four of the reviews were rated as {\textquoteleft}high{\textquoteright}-quality reviews, five as {\textquoteleft}acceptable{\textquoteright} and two as {\textquoteleft}low{\textquoteright}-quality reviews. CBT-based interventions delivered by multidisciplinary staff significantly reduced depressive symptoms, diabetes-related distress and HbA1c levels. CBT therapy delivered by CBT therapists was associated with significant reductions in diabetes-related distress, anxiety symptoms, depressive symptoms and HbA1c levels. Conclusions CBT and CBT-based interventions were similarly effective for depressive symptoms and HbA1c levels. Anxiety symptoms only improved following CBT delivered by CBT therapists, while diabetes-related distress reduced more than for CBT-based interventions. Significant heterogeneity and variation in quality in reviews mean that further research is required.",

keywords = "anxiety, cognitive behavioural therapy, depression, diabetes mellitus, psychological distress, review",

author = "Hanna Press and Leeanne Nicklas",

note = "Publisher Copyright: {\textcopyright} 2026 The Author(s). Diabetic Medicine published by John Wiley \& Sons Ltd on behalf of Diabetes UK.",

year = "2026",

month = feb,

day = "20",

doi = "10.1111/dme.70271",

language = "English",

journal = "Diabetic Medicine",

issn = "0742-3071",

publisher = "Wiley-Blackwell",

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AU - Press, Hanna

AU - Nicklas, Leeanne

PY - 2026/2/20

Y1 - 2026/2/20

N2 - Aims Significant evidence base supports cognitive behavioural therapy (CBT) for diabetes. Large variations in practice make it difficult to assess the impact of different types of delivery. This umbrella review aimed to synthesise evidence on the effectiveness of CBT and CBT-based interventions for diabetes-related distress, comorbid depressive symptoms, anxiety symptoms and HbA1c levels. A secondary aim investigated whether effectiveness differs in CBT delivered by a CBT therapist compared to CBT-based interventions that are delivered by multidisciplinary staff. Methods Databases like CINAHL, MEDLINE, PsychINFO, PsychArticles and Cochrane Library were searched for systematic reviews and meta-analyses between 2014 and 2023. Review quality was assessed using the Scottish Intercollegiate Guidelines Network checklist. For the secondary aim, findings of randomised controlled trials were distinguished within reviews. Results Eleven systematic reviews and meta-analyses were included. Four of the reviews were rated as ‘high’-quality reviews, five as ‘acceptable’ and two as ‘low’-quality reviews. CBT-based interventions delivered by multidisciplinary staff significantly reduced depressive symptoms, diabetes-related distress and HbA1c levels. CBT therapy delivered by CBT therapists was associated with significant reductions in diabetes-related distress, anxiety symptoms, depressive symptoms and HbA1c levels. Conclusions CBT and CBT-based interventions were similarly effective for depressive symptoms and HbA1c levels. Anxiety symptoms only improved following CBT delivered by CBT therapists, while diabetes-related distress reduced more than for CBT-based interventions. Significant heterogeneity and variation in quality in reviews mean that further research is required.

AB - Aims Significant evidence base supports cognitive behavioural therapy (CBT) for diabetes. Large variations in practice make it difficult to assess the impact of different types of delivery. This umbrella review aimed to synthesise evidence on the effectiveness of CBT and CBT-based interventions for diabetes-related distress, comorbid depressive symptoms, anxiety symptoms and HbA1c levels. A secondary aim investigated whether effectiveness differs in CBT delivered by a CBT therapist compared to CBT-based interventions that are delivered by multidisciplinary staff. Methods Databases like CINAHL, MEDLINE, PsychINFO, PsychArticles and Cochrane Library were searched for systematic reviews and meta-analyses between 2014 and 2023. Review quality was assessed using the Scottish Intercollegiate Guidelines Network checklist. For the secondary aim, findings of randomised controlled trials were distinguished within reviews. Results Eleven systematic reviews and meta-analyses were included. Four of the reviews were rated as ‘high’-quality reviews, five as ‘acceptable’ and two as ‘low’-quality reviews. CBT-based interventions delivered by multidisciplinary staff significantly reduced depressive symptoms, diabetes-related distress and HbA1c levels. CBT therapy delivered by CBT therapists was associated with significant reductions in diabetes-related distress, anxiety symptoms, depressive symptoms and HbA1c levels. Conclusions CBT and CBT-based interventions were similarly effective for depressive symptoms and HbA1c levels. Anxiety symptoms only improved following CBT delivered by CBT therapists, while diabetes-related distress reduced more than for CBT-based interventions. Significant heterogeneity and variation in quality in reviews mean that further research is required.

KW - anxiety

KW - cognitive behavioural therapy

KW - depression

KW - diabetes mellitus

KW - psychological distress

KW - review

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U2 - 10.1111/dme.70271

DO - 10.1111/dme.70271

M3 - Article

SN - 0742-3071

JO - Diabetic Medicine

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M1 - e70271

ER -

How effective are CBT and CBT-based interventions in Type 1 and Type 2 diabetes? An umbrella review

Abstract

UN SDGs

Keywords

ASJC Scopus subject areas

Access to Document

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