Gen Hosp Psychiatry. 2026 Mar 19;100:138-147. doi: 10.1016/j.genhosppsych.2026.03.018. Online ahead of print.
ABSTRACT
OBJECTIVE: Depression is a common and debilitating comorbidity in patients with type 2 diabetes mellitus (T2DM), adversely affecting glycemic control, complicating disease management, and increasing mortality risk. Non-pharmacological therapies are increasingly used to alleviate depression in T2DM, but their comparative efficacy remains unclear. This network meta-analysis (NMA) aims to compare the efficacy of different non-pharmacological therapies for depression in patients with T2DM, while also evaluating their effects on anxiety and glycemic control.
METHODS: We systematically searched PubMed, Embase, EBSCO, Cochrane Library, ScienceDirect, Web of Science, CNKI, WanFang, VIP, and CBM from the inception of each database until May 9, 2025, to identify randomized controlled trials (RCTs) evaluating the effects of seven non-pharmacological therapies on depression in patients with T2DM. When reported in the included trials, we also analyzed anxiety and glycemic control as secondary outcomes. Two reviewers independently screened studies, extracted data according to predefined criteria, and assessed the risk of bias using the Cochrane Risk of Bias Tool 2.0. The relative effectiveness of therapies was ranked using the Surface Under the Cumulative Ranking curve (SUCRA). Statistical analysis used R and Stata 15.0.
RESULTS: This NMA included 68 RCTs reporting depression outcomes from 10,090 patients. Among these trials, 28 also reported anxiety outcomes and 46 also reported glycemic control outcomes. The results demonstrated that acupoint therapy (SMD = -1.25, 95%CI [-2.13, -0.38]), comprehensive nursing intervention (SMD = -1.14, 95%CI [-1.75, -0.52]), and cognitive behavioral therapy (SMD = -1.11, 95%CI [-1.54, -0.67]) were more effective than usual care for improving depression in T2DM patients. For anxiety level reduction, exercise therapy (SMD = -1.51, 95%CI [-2.56, -0.47]) showed the greatest improvement among the therapies evaluated. Acupoint therapy (SMD = -2.24, 95%CI [-3.66, -0.82]) and exercise therapy (SMD = -1.56, 95%CI [-2.42, -0.70]) were associated with glycated hemoglobin reduction compared to usual care.
CONCLUSIONS: Acupoint therapy may be the most effective therapy for improving both depression levels and glycemic control in patients with T2DM, whereas exercise therapy may be the preferred option for reducing anxiety. However, these findings should be interpreted with caution due to the limited number of head-to-head trials and the moderate to low quality of evidence for most comparisons. Future high-quality RCTs should be conducted to validate these findings.
PMID:41904854 | DOI:10.1016/j.genhosppsych.2026.03.018
