Background: Patients with type 2 diabetes mellitus always face various challenges of self-management which leads to disproportionately high rates of psychological problems. Acceptance and commitment therapy has the potential to enhance psychological well-being and promote self-management engagement.

Objectives: This review aimed to provide a comprehensive examination of the effectiveness of ACT among patients with T2DM and identify the key characteristics of effective interventions. Design: Systematic review and meta-analysis

Methods: Nine English and Chinese databases were searched to identify the eligible randomized controlled trails which investigated the effectiveness of ACT from inception to November 2021. The eligibility of studies, quality appraisal, and data extraction were performed by two reviewers independently. The risk of bias and the quality of evidence were assessed respectively. Mata-analysis were performed using the Review Manager 5.3.

Results: A total of ten studies with 712 participants were included in this systematic review. Acceptance and commitment therapy was significantly effective for improving the patients’ glycemic control (MD: -0.95; 95%CI: -1.38 to -0.52; P<0.001; I2=62%) , acceptance for diabetes (MD: 7.80; 95%CI: 9.49; P<0.001; I2=0%) , self-efficacy (SMD: 1.00; 95%CI: 0.80 to 1.21; P<0.001; I2=14%) and anxiety (SMD: -1.15; 95%CI: -1.97 to -0.33; P=0.006; I2=90%) , but had no beneficial impact on self-care behaviors, distress, depression and psychological resilience. The certainty of evidence for outcomes were assessed as low to very low.

Conclusion: ACT may be helpful to improve patients’ psychology well-being and self-management for patients with T2DM. More rigorous studies with longer follow-up periods are warranted in view of the inconclusive findings and limited quality of evidence.


M.Wang: None. L.Cheng: None. X.Guo: None. Z.Zhu: None.

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