An Examination of the Effectiveness of Psychological Interventions for the Management of Type 2 Diabetes Mellitus in China

China has the largest number of type 2 diabetes mellitus (T2DM) cases globally and hence has a pressing need for effective management strategies. Evidence-based guidelines recognise the importance of a structured and systematic approach to the management of T2DM that incorporates psychological care within clinical recommendations. However, psychological care is a relatively new field in China and the utilisation and effectiveness of this aspect of care is relatively unknown. As such, this thesis sought to examine the effectiveness of psychological interventions for the management of T2DM in China. Two research studies were designed and executed in order to meet this aim.
   
   The systematic review and meta-analyses presented in Study One was the first to assess the effectiveness of psychological interventions in improving T2DM-related outcomes in China. The findings obtained supported the use of psychological therapies, namely cognitive behavioural therapy (CBT), motivational interviewing (MI), and client-centred therapy for the improvement of glycaemic and psychological outcomes of T2DM. However, only three studies were found that could be included in the meta-analysis for MI; the methodological quality of the majority of included studies was debatable; and only three studies (one utilising CBT; two utilising MI) were conducted within the community health setting. These notable limitations consequently limited the generalisability and statistical power of findings obtained in Study One.
   
   The lack of methodologically robust studies utilising MI within the community health setting consequently led to Study Two – the first large-scale pragmatic cluster randomised controlled trial of a T2DM management intervention that utilised health coaches trained in MI within community health stations in urban China. The findings obtained from this study opposed those that were obtained from the meta-analyses of Study One; no differential treatment effects were observed for glycated haemoglobin or the majority of secondary physiological, psychological and self-care outcomes.
   
   The overall findings obtained within this thesis indicate that it may be premature to recommend the routine delivery of psychological interventions (in particular, MI) for the management of T2DM in China. Additional high-quality, large-scale research is required that is conducted and reported according to recognised frameworks, such as the CONSORT statement. This will allow international standards to be met, will enable adequate risk of bias assessments to be performed, and will increase the rigor of future reviews.
   
   The two studies comprised within this thesis represent a foundational step toward the implementation of rigorously designed psychological interventions in China, specifically targeting T2DM. Given the combination of China’s increasing burden of T2DM and the governments’ strong commitment to healthcare reform, the opportunities for meaningful contributions in the field of chronic disease management in China are manifest. The Chinese government and Chinese Medical Association are striving to adopt best practice medical management and the continued examination of the effectiveness of psychological interventions in T2DM management is a worthy and important element.