[Pilot study of two different strategies to reinforce self care behaviors and treatment compliance among type 2 diabetes patients from low income strata]. Psychological family intervention for poorly controlled type 2 diabetes. A brief psychological intervention to improve adherence in type 2 diabetes. Clinical and Behavioral Correlates of Achieving and Maintaining Glycemic Targets in an Underserved Population With Type 2 Diabetes Assessment of two culturally competent Diabetes education methods: Individual versus Individual plus Group education in Canadian Portuguese adults with Type 2 Diabetes Therapeutic education among adults with type 2 diabetes: effects of a three-day intervention on perceived competence, self-management behaviours and glycaemic control Effect of psychological intervention on exercise adherence in type 2 diabetic subjects. A time-limited, problem-orientated psychotherapeutic intervention in Type 1 diabetic patients with complications: a randomized controlled trial. Reductions in Regimen Distress Are Associated With Improved Management and Glycemic Control Over Time Prospective study on influence of psychosocial factors on glycemic control in Japanese patients with type 2 diabetes. Self-monitoring of blood glucose--psychological aspects relevant to changes in HbA1c in type 2 diabetic patients treated with diet or diet plus oral antidiabetic medication. A randomized controlled trial on the effect of behavioral strategies for adherence to oral antidiabetic drugs: study protocol Impact of an education program on patient anxiety, depression, glycemic control, and adherence to self-care and medication in Type 2 diabetes Do the Effects of Psychological Treatments on Improving Glycemic Control in Type 1 Diabetes Persist Over Time? A Long-Term Follow-Up of a Randomized Controlled Trial Impact of family support improvement behaviors on anti diabetic medication adherence and cognition in type 2 diabetic patients Challenges and lessons learned in the development and implementation of a couples-focused telephone intervention for adults with type 2 diabetes: the Diabetes Support Project Effectiveness of educational interventions to promote oral hypoglycaemic adherence in adults with Type 2 diabetes: a systematic review
UNLABELLED Long term diabetes self-management behaviors , and strict glycemic control are difficult to achieve in clinical practice . OBJECTIVE Asesss two different reinforcement strategies for diabetes selfcare management , psychological distress and glycemic control in a one year follow up study . METHODS 70 consecutive type 2 diabetic patients , were recruited and r and omly assigned to three study groups . Subjects in the control group ( CG ) continued with their normal treatment schedule . The second group received a reinforcement course at 6 months ( RCG ) and in the third group , patients were contacted monthly by phone ( PHCG ) to promote self-management attitudes and address problems as they arose . A battery of questions and laboratory work-up were obtained at baseline and at one year follow-up . RESULTS At one year follow-up , the three groups significantly increased their diabetes-related knowledge . Both experimental groups displayed improved treatment compliance and had better adherence to the recommended meal plan ( p=0.06 and 0.003 ) . In addition , the PHCG significantly increased ( p<0.0001 ) their adherence to pharmacological treatment . No significant differences were observed in glycemic control , prevalence of depression or diabetes related distress . CONCLUSIONS Follow-up patient reinforcement strategies improve strategic diabetes self-care management behaviors . Further studies are needed to demonstrate the positive impact of these benefits on diabetes related outcomes OBJECTIVE To evaluate the effectiveness of a psychological , family-based intervention to improve diabetes-related outcomes in patients with poorly controlled type 2 diabetes . METHODS This study was a r and omized controlled trial of a psychological family-based intervention targeted at individuals with poorly controlled type 2 diabetes . Recruitment and follow-up occurred at specialist diabetes clinics . Patients were r and omly allocated to an  intervention group ( n=60 ) or a control group ( n=61 ) . Poor control was defined as at least 2 of the patient 's last 3 glycated hemoglobin (  A1C  )  readings at > 8.0 % . The intervention consisted of 2 sessions delivered by a health psychologist to the patient and a family member in the patient 's home , with a third session involving a 15-minute follow-up telephone call . RESULTS At 6-month follow-up , the intervention group reported significantly lower mean A1C levels than the control group ( 8.4 % [ SD=0.99 % ] vs 8.8 % [ SD=1.36 % ] ; P=.04 ) . The intervention was most effective in those with the poorest control at baseline ( A1C>9.5 % ) ( intervention 8.7 % [ SD=1.16 % , n=15 ] vs control 9.9 % [ SD=1.31 % , n=15 ] ; P=.01 ) . The intervention group also reported statistically significant improvements in beliefs about diabetes , psychological well-being , diet , exercise , and family support . CONCLUSIONS After participating in a family-based intervention targeting negative and /or inaccurate illness perceptions , patients with poorly controlled type 2 diabetes showed improvements in A1C levels and other outcomes . Our results suggest that adding a psychological , family-based component to usual diabetes care may help improve diabetes management OBJECTIVE Diabetes perceptions , acceptance and treatment motivation are changeable factors of adherence . This study aim ed to test the effects of brief psychological interventions based on diabetes threat and mastery perceptions in terms of adherence , acceptance and motivation . Physicians may find such interventions useful during a 15-minute consultation with diabetes patients . RESEARCH DESIGN AND METHODS This r and omized controlled study included 80 patients with type 2 diabetes , recruited from the hospital diabetes department , who were r and omly assigned to four intervention groups based on autobiographical recall . Those in the two intervention groups were asked to recall diabetic events based on mastery and threat perceptions , respectively , whereas those in the two control groups recalled non-diabetic events based on positive and negative emotions , respectively . Following this , all participants completed vali date d self- question naires assessing diabetes perceptions , acceptance , treatment motivation and adherence . RESULTS Patients in the threat group reported less adherence ( P<0.01 ) and less avoidance ( P<0.05 ) , and perceived diabetes as less threatening ( P<0.05 ) than those in the mastery group . Similar results were obtained when the threat group was compared with its matched negative-emotion control group ( P<0.05 , P<0.05 and P=0.087 , respectively ) . Patients in the mastery group reported feeling a stronger sense of mastery ( P<0.05 ) than those in their positive-emotion control group and greater treatment acceptance than those in the threat group ( P<0.01 ) . CONCLUSION Contrary to conventional medical belief , discussing threatening personal events with patients can yield positive results . Health professionals should take threat and mastery perceptions of diabetes into account during regular consultations with a view to improving treatment acceptance and adherence . With this brief intervention of type 2 diabetes patients , it was also more effective to alleviate their emotional difficulties than to enhance their perception of mastery OBJECTIVE —In an underserved Latino area , we established a disease-management program and proved its effectiveness . However , many patients still remained above target . This study was design ed to evaluate which factors are associated with reaching program goals . RESEARCH DESIGN AND METHODS —This was a r and omized , prospect i ve , observational study in which patients enrolled in our program were followed for 2 years with outcomes , measures , and question naires assessed at baseline and at 6 , 12 , and 24 months . RESULTS —Overall , A1C fell by 1 % . Adherence to medication was the strongest predictor of reaching the target A1C of < 8 % ; baseline A1C was also predictive . Knowledge scores increased in those who reached target , but the measures of self-efficacy and empowerment did not change for either group . CONCLUSIONS —Diabetes management is effective in a lower-income Latino population . However , adherence was suboptimal even when medications were provided on-site for free . Further research into barriers associated with medication adherence is needed Objective . To examine the impact of two culturally competent diabetes education methods , individual counselling and individual counselling in conjunction with group education , on nutrition adherence and glycemic control in Portuguese Canadian adults with type 2 diabetes over a three-month period . Design . The Diabetes Education Centre is located in the urban multicultural city of Toronto , Ontario , Canada . We used a three-month r and omized controlled trial design . Eligible Portuguese-speaking adults with type 2 diabetes were r and omly assigned to receive either diabetes education counselling only ( control group ) or counselling in conjunction with group education ( intervention group ) . Of the 61 patients who completed the study , 36 were in the counselling only and 25 in the  counselling with group education intervention . We used a per- protocol analysis to examine the efficacy of the two educational approaches on nutrition adherence and glycemic control ; paired t-tests to compare results within groups and analysis of covariance ( ACOVA ) to compare outcomes between groups adjusting for baseline measures . The Theory of Planned Behaviour was used to describe the behavioural mechanisms that influenced nutrition adherence . Results . Attitudes , subjective norms , perceived behaviour control , and intentions towards nutrition adherence , self-reported nutrition adherence and glycemic control significantly improved in both groups , over the three-month study period . Yet , those receiving individual counselling with group education showed greater improvement in all measures with the exception of glycemic control , where no significant difference was found between the two groups at three months . Conclusions . Our study findings provide preliminary evidence that culturally competent group education in conjunction with individual counselling may be more efficacious in shaping eating behaviours than individual counselling alone for Canadian Portuguese adults with type 2 diabetes . However , larger longitudinal studies are needed to determine the most efficacious education method to sustain long-term nutrition adherence and glycemic control The purpose of this study was to evaluate the impact of a three-day therapeutic education programme on perceived competence , self-management behaviours ( i.e. physical activity , diet and medication ) and glycaemic control among adults with type 2 diabetes . A total of 120 participants were included in this r and omized , wait list control group trial . The results confirm that therapeutic education may be a powerful healthcare intervention to improve lifestyle and health status of people with type 2 diabetes . We observed that the education programme used in this study generated positive changes in glycaemic control and adherence to physical activity and diet after three months follow-up . Furthermore , the intervention positively impacted participants ’ perceived competence towards physical activity and diet . The latter finding is of particular importance , given that perceived competence has been found to be involved in long-term adherence to self-management behaviours Previous research has pointed to the efficacy of physical activity in individuals suffering from type 2 diabetes mellitus ( type 2 DM ) . However , as with other population s , adherence to exercise programs is often problematic . This study assessed the effectiveness of a combination of exercise and psychological interventions in type 2 diabetics in terms of disease management and exercise adherence . Forty newly diagnosed type 2 diabetic subjects ( 54 + /- 6.5 years ) took part in the study . Subjects were allocated to an exercise-only intervention ( EO ) or a combined exercise and psychological adherence intervention ( EP ) group . Adherence to the program was also monitored at a 6-month follow-up . The results confirmed a significant improvement in physiological parameters ( total mass , fat mass , grip strength , peak flow , flexibility , and VO2 max ) after the 12-week program in both groups ( P < 0.001 ) . The EP group had significant changes in body fat , grip strength , and peak flow ( P < 0.05 ) in comparison to the EO group . Components of the visual analog mood scale ( VAMS ) were positively influenced in both groups from the therapy program ( P < 0.001 ) . The directed psychological intervention had a significant influence on attendance to the 12-week program ( P < 0.001 ) . This also result ed in significantly better adherence 6 months later ( P < 0.05 ) . In conclusion , the results have demonstrated that psychological intervention is of paramount importance for ensuring high adherence rates during exercise therapy for type 2 diabetic subjects AIMS To examine the effects of a time-limited , problem-orientated psychotherapeutic intervention on self-defined psychological problems and metabolic control in Type 1 diabetic patients with microvascular complications . DESIGN R and omized wait-list controlled trial with a follow-up of 6 months . SETTING Out-patient clinic of a university diabetes centre . PARTICIPANTS Forty-six Type 1 diabetic patients with intensified insulin therapy and presence of microvascular diabetic complications . Twenty-four patients were r and omly allocated to the intervention group and 22 patients to the control group . INTERVENTION Participation in a structured , problem-orientated , time-limited psychotherapeutic intervention ( IG ) . The control group ( CG ) patients received routine diabetes care in a specialized diabetes university clinic . OUTCOME MEASURES Degree of change of three self-defined main psychological and psychosocial problems ( no. 1 , no. 2 and no. 3 ) on a 1 - 10 grade d scale and glycosylated haemoglobin HbA1c values . RESULTS Two patients ( one in each group ) died during the study period . All remaining patients were followed for 6 months . Problem scores were high at baseline in both groups : IG/CG ( mean values , st and ard deviation in parentheses ) : problem no. 1 , 7.8 (2.0)/8.3 ( 1.7 ) ; problem no. 2 , 7.7 (2.3)/7.6 ( 1.8 ) ; and problem no. 3 , 7.7 (2.3)/7.4 ( 2.6 ) . At follow-up , all problems were significantly lower in the intervention group ( IG ) when compared with the CG : IG/CG : problem no. 1 , 4.3 (2.9)/6.8 ( 3.0 ) , P = 0.03 ; problem no. 2 , 3.9 (2.4)/5.8 ( 2.8 ) , P = 0.03 ; problem no. 3 , 4.7 (2.4)/6.8 ( 2.4 ) , P = 0.02 . Mean HbA1c decreased in the intervention group by 0.6 (1.2)% and increased in the control group by 0.1 (0.7)% , P = 0.016 . In patients with suboptimal metabolic control , i.e. HbA1c > 8 % , mean HbA1c decreased by 1.0 (1.2)% in the IG and increased by 0.1 (0.7)% in the CG , P = 0.011 . CONCLUSION A time-limited , structured , problem-orientated psychotherapeutic intervention decreases the severity of psychological problems and improves metabolic control in Type 1 diabetic patients with microvascular complications and self-management of intensified insulin therapy OBJECTIVE Cross-sectional and longitudinal associations among regimen  distress  ( RD ) , self-management , and glycemic control were undertaken to explore mechanisms of operation among these variables . RESEARCH DESIGN AND METHODS In a behavioral r and omized control trial ( RCT ) to reduce RD , 392 adults with type 2 diabetes were assessed for  RD , diet , exercise , medication adherence , and HbA1c at baseline and at 4 and 12 months . Associations among RD , self-management , and HbA1c were examined in cross-sectional analyses at baseline , in prospect i ve analyses using baseline values to predict change over time , and in time-varying analyses . RESULTS At baseline , greater RD and poorer medication adherence were independently associated with higher HbA1c ( P = 0.05 and P < 0.001 , respectively ) , and greater RD was associated with poorer medication adherence ( P = 0.03 ) . No consistent pattern of significant prospect i ve associations was found . Significant time-varying findings showed that decreases in RD were associated with improvements in medication adherence ( P < 0.01 ) , physical activity ( P < 0.001 ) , and HbA1c ( P = 0.02 ) over time following intervention . Changes in self-management were not associated with changes in HbA1c over time . CONCLUSIONS In the context of an RCT to reduce distress , RD , self-management , and HbA1c were interrelated in cross-sectional and time-varying analyses . Decreases in RD were associated with improvements in both self-management and HbA1c over 12 months . Findings point to the complex and likely multifaceted pathways of association among these key constructs , with results indicating significant linkages between RD and both self-management and glycemic control over time The authors prospect ively assessed the causal relationship between psychosocial factors and glycemic control in 256 Japanese out patients with Type 2 diabetes . Using structural-equation modeling , they first developed a causal model in which glycosylated hemoglobin ( HbA(1c ) ) at 6 months after assessment was influenced by the baseline psychosocial factors . Then , the reliability of the causal model was investigated with measurement of  HbA(1c ) at 12 months after baseline . Self-efficacy directly reinforced adherence , and adherence had a direct association with future HbA(1c ) . Other psychosocial factors , including social support , diabetes-related distress , daily burden , and emotion-focused coping prospect ively influenced HbA(1c ) indirectly through self-efficacy OBJECTIVE To investigate the influence of psychological aspects on glycemic control in type 2 diabetic patients treated with diet alone or diet plus oral antidiabetic medication using meal-related self-monitoring of blood glucose ( SMBG ) .  These psychological aspects refer to the process of self-management including the tendency to structure situations and activate re sources ( self-perception ) , to accept options for action ( self-reflection ) and to believe in self-efficacy ( self-regulation ) . METHODS In a r and omized controlled 6-month group comparison study , one group ( n = 113 ; mean age 58.7 years ) used a blood glucose monitoring device  , kept a blood glucose/eating diary and received st and ardized counseling focusing on self-perception , self-reflection and self-regulation .  A control group ( n = 110 ; mean age 60.5 years ) received non-st and ardized counseling on diet and lifestyle . RESULTS Statistically significant endpoint differences between the SMBG and the control group were seen in glycemic control ( p = 0.0086 ) and the well-being item ' depression ' ( p = 0.032 ) . All aspects of counseling were influenced by SMBG with the extent of self-perception and self-reflection gradually increasing over time . Three HbA1c response types were identified among SMBG patients : continuous-achievers , late-achievers and non-achievers . CONCLUSION This study identified processes ( structuring the situation and activating re sources , accepting options for action and believing in self-efficacy ) which lead to a change in the metabolic profile . SMBG coupled with structured counseling provided patients with a tool for taking on more self-control and result ed in an improved outlook on life . PRACTICE IMPLICATION S This short-term intervention involved a structured counseling algorithm which requires 5 - 10 min of physician-patient contact and a structured documentation of metabolic control by the patient and can be taught by a diabetes training team within 4 h. The identification of the different response types might be of importance in clinical practice as it enables the physician to determine the right counseling option Background : Non-adherence to oral antidiabetics drugs ( OADs ) has been a common problem and may contribute to poor glycemic control . Aim : To describe an experimental study protocol that aims at implementing and evaluating the effect of the “ action planning and coping planning ” interventions on medication adherence to OADs  in patients with type 2 diabetes mellitus ( T2DM ) in follow-up at primary care services . Design : A r and omized controlled trial . Methods : Two groups ( intervention and control ) will be followed over a period of 105 days . The intervention group will receive a combination of the “ action planning ” and “ coping planning ” intervention strategies . There will be in-person meetings and phone calls to reinforce the intervention . The control group will receive the usual care from the health unit . Conclusions : It is hoped that this study will help health professionals to improve their approach with patients who have T2DM in relation to medication adherence Background : Diabetes mellitus ( DM ) requires continuous medical care , patients ’ self-management , education , and adherence to prescribed medication to reduce the risk of long-term complications . The aim of this study was to assess the benefits of an education program on diabetes , patient self-management , adherence to medication , anxiety , depression and glycemic control in type 2 diabetics in Saudi Arabia . Material s and Methods : This was a prospect i ve study , conducted among 104 diabetic patients at a major tertiary hospital in Riyadh , Saudi Arabia , between May 2011 and October 2012 .  Education material s given to diabetic patients included pamphlets/h and outs written in Arabic , the national language . Special videotapes about DM were made and distributed to all participants . In addition , specific educational programs through the diabetes educators and one-on-one counseling sessions with the doctor were also arranged . Patients were interviewed using a structured interview schedule both during the baseline , and after 6 months of the program . The interview schedule included , socio-demographics , clinical characteristics , diabetes self-management , adherence to medication , anxiety , and depression . Glycemic control was considered poor , if hemoglobin A1c ( HbA1c ) was ≥ 7 % . Results : The mean age of the study population was 57.3 ± 14.4 years . Seventy one were males ( 68.3 % ) and 33 ( 31.7 % ) were females . After six months of the diabetes education program , there were significant improvements in patients ’ dietary plan ( P = 0.0001 ) , physical exercise ( P = 0.0001 ) , self-monitoring of blood glucose ( SMBG ) ( P = 0.0001 ) , HbA1c ( P = 0.04 ) , adherence to medication ( P = 0.007 ) , and depression ( P = 0.03 ) . Conclusions : Implementation of education programs on diabetes among type 2 diabetic patients is associated with better outcomes such as their dietary plan , physical exercise , SMBG , adherence to medication , HbA1c and depression Objectives In a r and omized controlled trial , adults with Type 1 diabetes and suboptimal glycemic control who received motivational enhancement therapy ( MET ) plus cognitive behavioral therapy ( CBT )  had a greater reduction in their 12-month hemoglobin A1c ( HbA1c ) than those who received usual care ( UC ) . We tested whether improvements in glycemic control persisted up to 4 years after r and omization . Methods In the original trial , participants were r and omized to UC ( n = 121 ) , 4 sessions of MET ( n = 117 ) , or 4 sessions of MET plus 8 sessions of CBT  ( n = 106 ) . Of the 344 patients who participated in the original trial , 260 ( 75.6 % ) consented to take part in this posttrial study . A linear mixed model was fitted to available measurements to assess whether intervention effects on HbA1c at 12 months were sustained at 2 , 3 , and 4 years . Results Estimated mean HbA1c level was lower for participants in the two intervention arms when compared with UC at 2 , 3 , and 4 years , but none of the differences were statistically significant . At 4 years , estimated mean HbA1c level  for MET plus CBT was 0.28 % ( 95 % confidence interval = −0.22 % to 0.77 % ) lower than that for UC , and estimated mean HbA1c level for MET was 0.17 % ( 95 % confidence interval = −0.33 % to 0.66 % ) lower than that for UC . Conclusions There was no evidence of benefit for patients r and omized to MET plus CBT at 2 , 3 , or 4 years . Larger studies are needed to estimate long-term treatment effects with greater precision . Current models of psychological treatments in diabetes may need to be intensified or include maintenance sessions to maintain improvements in glycemic control . Abbreviations RCT = r and omized controlled trial ; MET = motivational enhancement therapy ; CBT = cognitive behavioral therapy ; UC = usual Background Glycaemic control is the main goal of treatment for type 2 diabetic patients . Hyperglycaemia may result in cognitive decline . More family support may increase medication adherence and decrease glycaemic level . The purpose of this study was to determine the impact of family support improvement behavior on anti diabetic medication adherence and cognition in type 2 diabetic patients . Method The r and omized control trial study was conducted on 91 patients from an outpatient diabetes clinic . They were r and omly divided to intervention ( n = 45 ) and control  ( n = 46 ) group . Data on the patients ’ demographic information and their family gathered using a question naire , For two groups Morisky Medication Adherence Scale ( MMAS ) , drug administration part of  Diabetes Social Support Question naire – family version ( DSSQ ) , Number Connection Test ( NCT ) were applied and hemoglobin A1C was measured two times in the onset of study and three months later for control group and before and after intervention for intervention group . The key family members of the intervention group were taught according to their educational needs in small groups . Result In intervention group mean of NCT score was significantly decreased after intervention ( P = 0.006 ) however in the control group there was no significant difference after three months . In intervention group a significant correlation was noted between DSSQ scores and MMAS scores after intervention(r = 0.67 , P < 0.001 ) but , there was no significant correlation in the control group . Conclusion Family support instruction based on the educational needs of family members , may improve medication adherence through direct effect and cognitive status with indirect effect ABSTRACT Type 2 diabetes ( T2DM ) studies report that marital/family support relates to glycemic control , adherence , and quality of life . Yet , there are few reports on couples-focused interventions . This study aims to describe the challenges faced and lessons learned in the implementation of a theoretically based , couples intervention .  Three hundred fifty couples ( one partner has T2DM in poor glycemic control ) are r and omized to a couples intervention , individual intervention , or enhanced usual care .  All contacts are by telephone to increase reach . The medical ( e.g. , glycemic control ) , psychosocial ( e.g. , diabetes distress ) , and behavioral ( e.g. , regimen adherence ) outcomes were measured . Challenges in recruitment , assessment , and intervention with couples are described , with suggestions about how to address them . Findings concerning the efficacy and cost-effectiveness of the couples intervention , its effect on partners , and possible mechanisms of demonstrated changes , are anticipated in 2013 . Interventionists need specific skills to work with couples to promote communal coping and increase the likelihood of an efficacious couples intervention Executive summary Background As a chronic condition , the prevalence of Type 2 diabetes is increasing worldwide and adherence to oral medications , an essential component of self‐management , has been shown to improve glycaemic control . However compliance with oral medication adherence remains poor . Educating people with Type 2 diabetes is an important strategy to enhance self‐management ability , including medication‐taking behaviour . Objectives The overall objective of the review was to determine the effectiveness of educational interventions to promote oral hypoglycaemic adherence in adults with Type 2 diabetes . Inclusion criteria Types of participants Studies involving adults over 18 years old with Type 2 diabetes , with or without co‐morbidities , currently taking oral hypoglycaemic medication without insulin treatment , and with aglycated haemoglobin ( HbA1c ) > 7.0 % prior to the intervention were considered . Aglycated haemoglobin ( HbA1c ) concentration of less than 7.0 % , is important in order to delay or prevent diabetes‐related complications . Participants could be from the primary , tertiary or acute care setting . Types of intervention The review focused on various forms of educational interventions delivered by healthcare professionals aim ed at improving participants ’ knowledge . Types of outcomes The review evaluated outcomes measuring oral hypoglycaemic adherence including HbA1c , fasting blood glucose levels and other relevant indicators . Types of studies Studies that were r and omized controlled trials ( RCTs ) or case‐control studies were considered . Search strategy A three‐stage search strategy was employed . Papers in English and between the years 1990‐2009 were search ed in the following data bases : CINAHL , Medline , Mosby 's Nursing Consult , PsycINFO , PubMed , ScienceDirect , Scopus , TRIP and Web of Science . Full text was retrieved when the titles and abstract s of studies fulfilled the inclusion criteria . Method ological quality Full papers were assessed for method ological quality independently by two review ers using critical appraisal checklists from the Joanna Briggs Institute ( JBI ) . A third review er was consulted whenever there were disagreements between the two review ers . Data collection / extraction Details of each study included in the review were extracted using st and ardized data extraction forms developed by JBI . Extraction was conducted independently by two review ers . Data synthesis Meta‐ analysis was not possible due to method ological and statistical heterogeneity of the included studies . Hence study findings are presented in narrative form . Results Seven studies included in the final review consisted of seven RCTs . Five studies concluded that the educational intervention was effective in promoting oral hypoglycaemic adherence compared to usual care . These included pharmacist‐led interventions , individual diabetes education provided by nurses and diabetes group education based on a self‐management approach . Similarities among these interventions were provision of information on oral hypoglycaemic medication and the need for regular education sessions . However , small sample s in some studies limited generalization of results . Conclusions Implication s for practice Increased knowledge of oral hypoglycaemic issues and reinforcement of the importance of medication adherence were useful in promoting adherence . Regular education sessions allow individuals to reinforce information and educators to identify barriers to medication adherence . Educational interventions focusing on self‐management strategies appear more likely to achieve positive outcomes . Implication s for research Further trials involving larger sample s and population s with poor glycaemic control are needed . The effects of educational interventions , influence of additional take‐home written material , the optimal interval length of follow‐up and duration of education sessions , and specific processes of individual or group education which have been identified as effective need further exploration
INTERPRETATION In type 2 diabetes , there are improvements in long-term glycaemic control and psychological distress but not in weight control or blood glucose concentration in people who receive psychological therapies
BACKGROUND Adherence difficulties and psychological problems are associated with poor glycaemic control  in diabetes .
We undertook a systematic review and meta- analysis of psychological therapies to assess their effectiveness in improving glycaemic control in type 2 diabetes .