ABSTRACT
AIMS: The clinical relevance of diabetes-distress is increasingly recognized, but little is known about the efficacy of interventions specifically targeted to treat elevated diabetes-distress. Therefore, this systematic review sought to determine the efficacy of psychological interventions aimed at treating elevated diabetes-distress in people with Type 1 or Type 2 diabetes. METHODS: We systematically searched literature from five databases. Randomized controlled trials (RCTs) with an English abstract, describing the results of a psychological intervention in adults with diabetes were included. Articles were eligible for inclusion if the primary outcome was diabetes-distress measured by the Problem Areas in Diabetes Scale (PAID-5/PAID-20) or the Diabetes Distress Scale (DDS-17). Only mean group diabetes-distress values above cut-off at baseline or the results of a subgroup above cut-off (PAID-5 ≥ 8, PAID-20 ≥ 40 or DDS-17 ≥ 3) were included. RESULTS: The search yielded 8907 articles. After removing 2800 duplicates, 6107 articles remained. Titles and abstracts were screened, leaving 394 potential articles of interest, nine of which were RCTs. In a random-effects meta-analysis, the pooled effect size for diabetes-distress was 0.48 (Cohen's d), Z = 3.91, P < 0.0001. Statistical heterogeneity was I² = 46.67% (confidence intervals 45.06% to 48.28%). Diabetes-tailored psychological interventions reduced HbA1c (Cohen's d = 0.57), whereas mindfulness-based interventions did not (Cohen's d = 0.11). CONCLUSIONS: This systematic review shows that specifically diabetes-tailored psychological interventions are effective in reducing elevated diabetes-distress and HbA1c . More rigorous studies are warranted to establish the full potential of these interventions. PROSPERO database registration ID: CRD42017075290.
Subject(s)
Diabetes Mellitus/psychology , Fear , Hypoglycemia/psychology , Mass Screening/methods , Psychometrics/methods , Surveys and Questionnaires , Adult , Aged , Diabetes Mellitus/drug therapy , Fear/psychology , Female , Humans , Hypoglycemia/chemically induced , Hypoglycemic Agents/therapeutic use , Male , Middle Aged , Time FactorsABSTRACT
OBJECTIVE: To investigate the role of gamma/delta T cells in Mycobacterium tuberculosis-induced rat adjuvant arthritis. METHODS: Rats with adjuvant arthritis were injected with anti-T cell receptor gamma/delta (anti-TCRgamma/delta) monoclonal antibody V65 according to a preventive protocol, a pre-arthritis peak protocol, and a late therapeutic protocol. Arthritis severity and joint destruction were monitored, and depletion of target cells was analyzed by flow cytometry. RESULTS: Although all protocols led to successful depletion of TCRgamma/delta(bright) cells in peripheral blood and lymph nodes, none of the regimens influenced clinical parameters of adjuvant arthritis. If rats were treated before the clinical peak of adjuvant arthritis, however, joint destruction was significantly more severe than in vehicle-treated rats. CONCLUSION: Rat adjuvant arthritis is not promoted or perpetuated by gamma/delta T cells. Aggravation of joint destruction with pre-arthritis peak anti-gamma/delta treatment suggests a stage-dependent protective role of gamma/delta T cells in adjuvant arthritis.
Subject(s)
Arthritis, Experimental/pathology , Arthritis, Experimental/physiopathology , Receptors, Antigen, T-Cell, gamma-delta/metabolism , T-Lymphocytes/pathology , T-Lymphocytes/physiology , Animals , Animals, Newborn , Antibodies, Monoclonal/adverse effects , Antibodies, Monoclonal/immunology , Antibodies, Monoclonal/therapeutic use , Arthritis, Experimental/prevention & control , Cell Count , Disease Progression , Dose-Response Relationship, Drug , Female , Joints/pathology , Lymphocyte Activation , Pilot Projects , Rats , Rats, Inbred Lew , Receptors, Antigen, T-Cell, gamma-delta/immunologyABSTRACT
Large multilamellar liposomes containing dichloro-methylene-bisphosphonate (clodronate; Clo), a bisphosphonate that becomes toxic when intracellularly concentrated, were used to therapeutically target macrophages (M phi) in rats with established adjuvant arthritis (AA; i.v. on days 10,11,12) or antigen-induced arthritis (AIA; i.v. or i.a. on 3 h, days 1,2). In established AA, i.v. injection of Clo-liposomes led to significant, long-lasting amelioration of clinical parameters, and to reduced destruction of the ankle joint even several weeks after termination of treatment. In the acute phase of established AIA, intravenous treatment induced transient clinical amelioration, but did not counteract joint destruction. I.a. treatment in AIA was ineffective. Systemic treatment with anti-M phi principles induces amelioration of both AA and AIA; the improvement appears more profound in AA, i.e., the model with a more systemic character. Preliminary data indicate that depletion of M phi occurs in the liver rather than in spleen, draining lymph nodes or synovial membrane. In addition, local treatment with the same principle is ineffective in AIA. Therefore, systemic elimination of M phi in different sites may be crucial for effective therapy of arthritis with anti-M phi agents.
