Effectiveness of cognitive-behavioral therapy in diabetes self-management and HbA1C level in patients with type 2 diabetes

Document Type : Original Article


1 Department of Psychology, Karaj Branch, Islamic Azad University, Karaj, Iran.

2 Department of Psychology, Payame Noor University, Semnan, Iran.



Background: Observing self-care activities have a great impact on the physical and mental performance of patients with diabetes.
Objective: This study aimed to determine the effectiveness of cognitive-behavioral therapy on diabetes self-management and HbA1C level in patients with type 2 diabetes.
Methods: The method of this study was applied and quasi-experimental designs of pre-test-post-test and follow-up with the control group. The statistical population of the study consisted of 25-55 years old diabetic patients referred to one of the health centers in Ghaemshahr in 2020, among which 30 people were selected by purposeful sampling method and were assigned to two groups of cognitive-behavioral therapy (n=15) and control group (n=15). Data were obtained through Tobert and Glasgow Diabetes Self-Management Questionnaire (2002) and glycosylated hemoglobin test (HbA1c). Repeated measure analysis of variance and SPSS.22 software were used for data analysis.
Results: The results showed that the cognitive-behavioral group had a significant effect on diabetes self-management and hypoglycemia (p<0.001). Also, the effectiveness of cognitive-behavioral therapy on diabetes self-management and HbA1C levels in patients with type 2 diabetes remained stable three months after the intervention.
Conclusion: It can be concluded that cognitive-behavioral therapy was effective on diabetes self-management and HbA1C level in patients with type 2 diabetes.


 1.Alanzi T. Role of social media in diabetes management
in the middle east region: systematic review. Journal of
medical Internet research. 2018;20(2):58-63.
2.American Diabetes Association. Economic costs of
diabetes in the US in 2017. Diabetes care.
2018;41(5):917-28. https://doi.org/10.2337/dci18-0007
3.Ausili D, Barbaranelli C, Rossi E, Rebora P, Fabrizi D,
Coghi C, Luciani M, Vellone E, Di Mauro S, Riegel B.
Development and psychometric testing of a theory-based
tool to measure self-care in diabetes patients: the SelfCare of Diabetes Inventory. BMC Endocrine Disorders.

Moeini Koochaksaraee F et al.
50 Razavi Int J Med. 2022; 10(2):e1161.
4.American Diabetes Association. 2. Classification and
diagnosis of diabetes. Diabetes care. 2017;40(1):11-24.
5.Andreae SJ, Andreae LJ, Richman JS, Cherrington AL,
Safford MM. Peer-delivered cognitive behavioral
training to improve functioning in patients with diabetes:
a cluster-randomized trial. The Annals of Family
6.Arafat Y, Mohamed Ibrahim MI, Awaisu A. Using the
transtheoretical model to enhance self-management
activities in patients with type 2 diabetes: A systematic
review. Journal of pharmaceutical health services
7.Asmat U, Abad K, Ismail K. Diabetes mellitus and
oxidative stress—A concise review. Saudi
Pharmaceutical Journal. 2016;24(5):547-53.
8.Azami G, Soh KL, Sazlina SG, Salmiah M, Aazami S,
Mozafari M, Taghinejad H. Effect of a nurse-led
diabetes self-management education program on
glycosylated hemoglobin among adults with type 2
diabetes. Journal of diabetes research.2018;2(1):18-28.
9.Beck AT, Davis DD, Freeman A, editors. Cognitive
therapy of personality disorders. Guilford Publications;
10.Bullard KM, Cowie CC, Lessem SE, Saydah SH,
Menke A, Geiss LS, Orchard TJ, Rolka DB, Imperatore
G. Prevalence of diagnosed diabetes in adults by
diabetes type—United States, 2016. Morbidity and
Mortality Weekly Report.2018;67(12):359-66.
11.Chai S, Yao B, Xu L, Wang D, Sun J, Yuan N, Zhang
X, Ji L. The effect of diabetes self-management
education on psychological status and blood glucose in
newly diagnosed patients with diabetes type 2. Patient
education and counseling.2018;101(8):1427-32.
12.Chamberlain JJ, Rhinehart AS, Shaefer Jr CF,
Neuman A. Diagnosis and management of diabetes:
synopsis of the 2016 American Diabetes Association
Standards of Medical Care in Diabetes. Annals of
internal medicine. 2016;164(8):542-52.
13.Cho N, Shaw JE, Karuranga S, Huang Y, da Rocha
Fernandes JD, Ohlrogge AW, Malanda B. IDF Diabetes
Atlas: Global estimates of diabetes prevalence for 2017
and projections for 2045. Diabetes research and clinical
14.Cummings DM, Lutes LD, Littlewood K, Solar C,
Carraway M, Kirian K, Patil S, Adams A, Ciszewski S,
Edwards S, Gatlin P. 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.
15.Carpenter R, DiChiacchio T, Barker K. Interventions
for self-management of type 2 diabetes: An integrative
review. International journal of nursing sciences.
16.Chrvala CA, Sherr D, Lipman RD. Diabetes selfmanagement education for adults with type 2 diabetes
mellitus: a systematic review of the effect on glycemic
control. Patient education and counseling.
17.Clarke J, Sanatkar S, Baldwin PA, Fletcher S, Gunn
J, Wilhelm K, Campbell L, Zwar N, Harris M, Lapsley
H, Hadzi-Pavlovic D. A web-based cognitive behavior
therapy intervention to improve social and occupational
functioning in adults with type 2 diabetes (the
springboard trial): randomized controlled trial. Journal of
medical Internet research.2019;21(5):12-24.
18.Colberg SR, Sigal RJ, Yardley JE, Riddell MC,
Dunstan DW, Dempsey PC, Horton ES, Castorino K,
Tate DF. Physical activity/exercise and diabetes: a
position statement of the American Diabetes
Association. Diabetes care. 2016;39(11):2065-79.
19.Davies MJ, D’Alessio DA, Fradkin J, Kernan WN,
Mathieu C, Mingrone G, Rossing P, Tsapas A, Wexler
DJ, Buse JB. Management of hyperglycemia in type 2
diabetes, 2018. A consensus report by the American
Diabetes Association (ADA) and the European
Association for the Study of Diabetes (EASD). Diabetes
20.De Boer IH, Bangalore S, Benetos A, Davis AM,
Michos ED, Muntner P, Rossing P, Zoungas S, Bakris G.
Diabetes and hypertension: a position statement by the
American Diabetes Association. Diabetes care.
2017;40(9):1273-84. https://doi.org/10.2337/dci17-0026
21.Jannoo Z, Wah YB, Lazim AM, Hassali MA.
Examining diabetes distress, medication adherence,
diabetes self-care activities, diabetes-specific quality of
life and health-related quality of life among type 2
diabetes mellitus patients. Journal of clinical &
translational endocrinology. 2017;9:48-54.
22.Guicciardi M, Lecis R, Anziani C, Corgiolu L, Porru
A, Pusceddu M, Spanu F. Type 2 diabetes mellitus,
physical activity, exercise self-efficacy, and body
satisfaction. An application of the transtheoretical model
in older adults. Health Psychology and Behavioral
Medicine: An Open Access Journal. 2014;2(1):748-58.
23.Pan X, Wang H, Hong X, Zheng C, Wan Y, Buys N,
Zhang Y, Sun J. A Group-Based Community
Reinforcement Approach of Cognitive Behavioral
Therapy Program to Improve Self-Care Behavior of
Patients with Type 2 Diabetes. Frontiers in Psychiatry.
2020;11:719. https://doi.org/10.3389/fpsyt.2020.00719

Moeini Koochaksaraee F et al.
Razavi Int J Med. 2022; 10(2):e1161. 51
24.Yang X, Li Z, Sun J. Effects of Cognitive Behavioral
Therapy–Based Intervention on Improving Glycaemic,
Psychological, and Physiological Outcomes in Adult
Patients With Diabetes Mellitus: A Meta-Analysis of
Randomized Controlled Trials. Frontiers in psychiatry.
2020;11:711. https://doi.org/10.3389/fpsyt.2020.00711
25.Menting J, Tack CJ, Donders R, Knoop H. Potential
mechanisms involved in the effect of cognitive
behavioral therapy on fatigue severity in Type 1
diabetes. Journal of consulting and clinical psychology.
2018;86(4):330. https://doi.org/10.1037/ccp0000290
26.Sina M, Graffy J, Simmons D. Associations between
barriers to self-care and diabetes complications among
patients with type 2 diabetes. Diabetes research and
27.Wang ZD, Xia YF, Zhao Y, Chen LM. Cognitive
behavioural therapy on improving the depression
symptoms in patients with diabetes: a meta-analysis of
randomized control trials. Bioscience reports.
2017;37(2):35-54. https://doi.org/10.1042/BSR20160557
28.Talbot LS, Maguen S, Metzler TJ, Schmitz M,
McCaslin SE, Richards A, Perlis ML, Posner DA, Weiss
B, Ruoff L, Varbel J. Cognitive behavioral therapy for
insomnia in posttraumatic stress disorder: a randomized
controlled trial. Sleep. 2014;37(2):327-41.
29.Young-Hyman D, De Groot M, Hill-Briggs F,
Gonzalez JS, Hood K, Peyrot M. Psychosocial care for
people with diabetes: a position statement of the
American Diabetes Association. Diabetes care.
2016;39(12):2126-40. https://doi.org/10.2337/dc16-2053