title: An updated meta-analysis to assess the effectiveness of psychological interventions delivered by psychological specialists and generalist clinicians on glycaemic control and on psychological status.
abstract: OBJECTIVE
  To update a meta-analysis and determine the effectiveness of psychological interventions on glycaemic control measured by HbA(1c) and psychological status in type 2 diabetes and to compare effects when interventions are delivered by generalist clinicians compared to psychological specialists.
  
  
  METHODS
  We used the original review protocol and searched the Cochrane central register of controlled trials, Medline, Embase, PsychLIT, and Google Scholar from February 2003 (end of previous review) to March 2007. We extracted data on the participants, interventions, delivery methods, comparison groups and outcome measures.
  
  
  RESULTS
  35 trials were reviewed and meta-analysis of 19 trials (n=1431), reporting HbA(1c) found a reduction in HbA(1c) by 0.54% (-0.32; 95% CI: -0.47 to -0.16). In nine trials (n=832) interventions were delivered by diabetes or general clinicians reducing HbA(1c) by 0.51% (-0.27; 95% CI: -0.50 to 0.04). In nine trials, interventions (n=561) were delivered by psychological specialists reducing HbA(1c) by 0.57% (-0.36; 95% CI: -0.61 to 0.12). Meta-analysis of 13 trials reporting psychological status found psychological status to be lower in the intervention groups -0.56 (95% CI: 1.00 to -0.13). Trial quality for the majority of studies remained poor.
  
  
  CONCLUSIONS
  Our findings suggest that psychological and general clinicians are similarly effective in delivering psychological interventions, however, effect sizes for all clinicians have reduced since the earlier review.
  
  
  CONCLUSIONS
  Psychological training opportunities for generalist clinicians could lead to wider availability of effective psychological care.
authors.affiliation: Health Sciences Research Institute, Warwick Medical School, University of Warwick, Gibbet Hill, Coventry CV4 7AL, UK. R.Alam@warwick.ac.uk
authors.forename: Rahul
authors.initials: R
authors.lastname: Alam
authors.forename: Jackie
authors.initials: J
authors.lastname: Sturt
authors.forename: Ranjit
authors.initials: R
authors.lastname: Lall
authors.forename: Kirsty
authors.initials: K
authors.lastname: Winkley
mesh_terms: D000223:Adaptation, Psychological; D003376:Counseling / Q000193:education; D003924:Diabetes Mellitus, Type 2 / Q000628:therapy*; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D011369:Professional-Patient Relations; D011584:Psychology / Q000193:education; D011613:Psychotherapy / Q000193:education; D012648:Self Care / Q000523:psychology*
chemical_list: D006442:Glycated Hemoglobin