The Efficacy of Behavioral Interventions on Cardiovascular Risk Factors in Patients With Type 2 Diabetes: A Systematic Review and Network Meta-Analysis of Randomized Trials Publisher Pubmed



Dankoob V ; Shahinfar H ; Ostevari A ; Norouziasl R ; Mohieddin N ; Esmaeili F ; Rafiei F ; Shabbidar S
Source: Diabetes Research and Clinical Practice Published:2026

Abstract

This study aimed to assess, compare, and rank the effects of different behavioral interventions on key cardiovascular risk factors in adults with type 2 diabetes. We searched PubMed, Scopus, and Web of Science up to March 2025. A random-effects network meta-analysis with a Frequentist framework was conducted to estimate mean differences (MDs) and 95% confidence intervals (CIs). The certainty of evidence was rated using the GRADE approach. Standard behavioral therapy (SBT) improved short-term glycemic control, reducing HbA1c by 0.24% (95% CI: −0.41, −0.06) at 0–3 months with moderate-certainty evidence. Multicomponent interventions, particularly those combining cognitive behavioral therapy (CBT), SBT, and motivational interviewing (MI), showed the largest and most sustained effects, achieving a 1.84% HbA1c reduction (95% CI: −2.04, −1.63) at 12–36 months compared with SBT alone. SBT also reduced systolic blood pressure and increased HDL cholesterol. Ranking analyses indicated that SBT + mindfulness-based interventions, ACT/DBT-based approaches, and CBT + SBT + MI were most effective for HbA1c reduction. For fasting blood glucose, CBT combined with SBT or MI showed the highest effectiveness, while SBT plus control ranked well at 6–12 months. Overall, multicomponent behavioral strategies appear most effective for sustained HbA1c improvement, although stronger evidence is needed for fasting glucose and adiposity outcomes. © 2026 Elsevier B.V.