Archive \ Volume.12 2021 Issue 3

Systematic Review of Psychological and Educational Interventions Used to Improving Adherence in Diabetes and Depression Patients

Tibyan Bashir, Hana Morrissey, Patrick Ball

Diabetes is a life-long chronic condition that is an established risk factor for the development of comorbid depression and possibly affecting medication adherence. Psychological and educational interventions are reported efficacious by the National Institute for Health and Care Excellence (NICE) in treating depression associated with a comorbid condition. As depression is associated with low adherence rates to treatment regimens, improving depression outcomes could improve adherence and therefore glycaemic control. A search strategy was conducted on search engines Google Scholar, PubMed, and Cochrane library for clinical trials. A total of 10 Randomised controlled trials (RCTs) were identified which investigated the effects of psychological and educational interventions on Type 2 diabetic patients with comorbid depression. Outcomes measured were depression and glycaemic control. Evidence from the 10 RCTs with 5759 participants suggests that psychological and educational intervention improved depression outcomes substantially and glycaemic control to an extent. Depression outcomes results were significant: standard mean deviation (SMD) was -0.39 (95% CI -0.62, -0.15); I2= 81%) p<0.001. Diabetes outcomes were not seen to be significant, SMD was -0.14 (95% CI -0.32, 0.03); I2= 44%) p=0.12. Psychological and educational interventions are effective in improving depression symptoms significantly and may assist in glycaemic control. Further research is required using larger sample sizes that could be generalized and representative of the whole population.

How to cite:
Bashir T, Morrissey H, Ball P. Systematic Review of Psychological and Educational Interventions Used to Improving Adherence in Diabetes and Depression Patients. Arch Pharm Pract. 2021;12(3):1-11.
Bashir, T., Morrissey, H., & Ball, P. (2021). Systematic Review of Psychological and Educational Interventions Used to Improving Adherence in Diabetes and Depression Patients. Archives of Pharmacy Practice, 12(3), 1-11.

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1.        Diabetes UK. Facts & Figures. [online] Diabetes UK. 2019. Available from: <> [Accessed 23 March 2021].

2.        Ahmed IA, Alosaimi ME, Alkhathami SM, Alkhurayb NT, Alrasheed MS, Alanazi ZM, et al. Knowledge, attitude, and practices towards diabetes mellitus among non-diabetes community members of Riyadh, Kingdom of Saudi Arabia. Int J Pharm Res Allied Sci. 2020;9(1):41-51.

3.        Soep S, Agussalim A. The impact of health education about Diabetes mellitus on patient knowledge to control their Blood Sugar. J Adv Pharm Edu Res. 2020;10(3):141-5.

4.        Lindenmeyer A, Hearnshaw H, Vermeire E, Van Royen P, Wens J, Biot Y. Interventions to improve adherence to medication in people with type 2 diabetes mellitus: a review of the literature on the role of pharmacists. J Clin Pharm Ther. 2006;31(5):409-19. 

5.        NICE CKS. Depression | Health topics A to Z | CKS | NICE. [online] 2020. Available from: <> [Accessed 23 March 2021].

6.        Chatterjee S, Khunti K, Davies MJ. Type 2 diabetes. Lancet. 2017;389(10085):2239-51.

7.        National Institute of Mental Health. NIMH » Chronic Illness and Mental Health: Recognizing and Treating Depression. [online] Available from: <> [Accessed 23 March 2021].

8.        Horne R. Medication adherence: A review of existing research. In L. B. Myers & K. Midence (Eds.), Adherence to treatment in medical conditions. Harwood Acad Publishers. 1998:285-310.

9.        Bastakoti S, Khanal S, Dahal B, Pun NT. Adherence and non-adherence to treatments: focus on pharmacy practice in Nepal. J Clin Diagn Res: JCDR. 2013;7(4):754.

10.      Wroe AL. Intentional and unintentional nonadherence: a study of decision making. J Behav Med. 2002;25(4):355-72.

11.      Osterberg L, Blaschke T. Adherence to medication. N Engl J Med. 2005;353(5):487-97.

12.      Mind UK. What is CBT? [online] 2021. Available from: <> [Accessed 23 March 2021].

13.      Glazier RH, Bajcar J, Kennie NR, Willson K. A systematic review of interventions to improve diabetes care in socially disadvantaged populations. Diabetes Care. 2006;29(7):1675-88.

14.      Crawshaw J, Auyeung V, Ashworth L, Norton S, Weinman J. Healthcare provider-led interventions to support medication adherence following ACS: a meta-analysis. Open Heart. 2017;4(2):e000685.

15.      Beck AT, Dozois DJ. Cognitive therapy: current status and future directions. Annu Rev Med. 2011;62(1):397-409.

16.      Diabetes UK. [online]. 2021. Available from: <> [Accessed 23 March 2021].

17.      Bădescu SV, Tătaru C, Kobylinska L, Georgescu EL, Zahiu DM, Zăgrean AM, et al. The association between diabetes mellitus and depression. J Med Life. 2016;9(2):120.

18.      Huang Y, Wei X, Wu T, Chen R, Guo A. Collaborative care for patients with depression and diabetes mellitus: a systematic review and meta-analysis. BMC Psychiatry. 2013;13(1):1-1.

19.      Critical Appraisal Skills Programme UK. CASP checklists. 2021. Available from: Accessed on:15/3/2021.

20.      Moher D, Liberati A, Tetzlaff J, Altman DG, Prisma Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6(7):e1000097. doi:10.1371/journal.pmed.1000097

21.      Methley AM, Campbell S, Chew-Graham C, McNally R, Cheraghi-Sohi S. PICO, PICOS, and SPIDER: a comparison study of specificity and sensitivity in three search tools for qualitative systematic reviews. BMC Health Serv Res. 2014;14(1):579. doi:10.1186/s12913-014-0579-0

22.      Review Manager Web (RevMan Web). Version (version number). The Cochrane Collaboration, (version date). Available from: Accessed on:15/3/2021. 

23.      Inoue T, Tanaka T, Nakagawa S, Nakato Y, Kameyama R, Boku S, et al. Utility and limitations of PHQ-9 in a clinic specializing in psychiatric care. BMC Psychiatry. 2012;12(1):1-6.

24.      Beck AT, Steer RA, Carbin MG. Psychometric properties of the Beck Depression Inventory: Twenty-five years of evaluation. Clin Psychol Rev. 1988;8(1):77-100.

25.      Burckhardt CS, Anderson KL. the Quality of Life Scale (QOLS): Reliability, Validity, and Utilisation. Health Qual Life Outcomes. 2003;1:60.

26.      Huang CY, Lai HL, Chen CI, Lu YC, Li SC, Wang LW, et al. Effects of motivational enhancement therapy plus cognitive behaviour therapy on depressive symptoms and health-related quality of life in adults with type II diabetes mellitus: a randomised controlled trial. Qual Life Res. 2016;25(5):1275-83.

27.      Lauffenburger JC, Lewey J, Jan S, Makanji S, Ferro CA, Krumme AA, et al. Effectiveness of targeted insulin-adherence interventions for glycemic control using predictive analytics among patients with type 2 diabetes: a randomized clinical trial. JAMA Netw Open. 2019;2(3):e190657.

28.      Bogner HR, Morales KH, de Vries HF, Cappola AR. Integrated management of type 2 diabetes mellitus and depression treatment to improve medication adherence: a randomized controlled trial. Ann Fam Med. 2012;10(1):15-22.

29.      Cummings DM, Lutes LD, Littlewood K, Solar C, Carraway M, Kirian K, et al. Randomized trial of a tailored cognitive behavioral intervention in type 2 diabetes with comorbid depressive and/or regimen-related distress symptoms: 12-month outcomes from COMRADE. Diabetes Care. 2019;42(5):841-8.

30.      Sharif F, Masoudi M, Ghanizadeh A, Dabbaghmanesh MH, Ghaem H, Masoumi S. The effect of cognitive-behavioral group therapy on depressive symptoms in people with type 2 diabetes: A randomized controlled clinical trial. Iran J Nurs Midwifery Res. 2014;19(5):529.

31.      Piette JD, Richardson C, Himle J, Duffy S, Torres T, Vogel M, et al. A randomized trial of telephone counseling plus walking for depressed diabetes patients. Med Care. 2011;49(7):641.

32.      Newby J, Robins L, Wilhelm K, Smith J, Fletcher T, Gillis I, et al. Web-based cognitive behavior therapy for depression in people with diabetes mellitus: a randomized controlled trial. J Med Intern Res. 2017;19(5):e157.

33.      Williams Jr JW, Katon W, Lin EH, Nöel PH, Worchel J, Cornell J, et al. The effectiveness of depression care management on diabetes-related outcomes in older patients. Ann Intern Med. 2004;140(12):1015-24.

34.      Ell K, Katon W, Xie B, Lee PJ, Kapetanovic S, Guterman J, et al. Collaborative care management of major depression among low-income, predominantly Hispanic subjects with diabetes: a randomized controlled trial. Diabetes Care. 2010;33(4):706-13.

35.      Weinger K, Beverly EA, Lee Y, Sitnokov L, Ganda OP, Caballero AE. The effect of a structured behavioral intervention on poorly controlled diabetes: a randomized controlled trial. Arch Intern Med. 2011;171(22):1990-9.

36.      National Institute for Health and Care Excellence. Recommendations | Depression in adults with a chronic physical health problem: recognition and management | Guidance | NICE. [online] Available from: <> [Accessed 23 March 2021].

37.      Brown MT, Bussell JK. Medication adherence: WHO cares? InMayo clinic proceedings. Elsevier. 2011;86(4):304-14.

38.      National Health Service. Overview - Cognitive behavioural therapy (CBT). [online] 2021. Available from: <> [Accessed 23 March 2021].

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