Effectiveness of Motivational Interviewing on patients with Type 2 Diabetes Mellitus: A Systematic Review and Meta-Analysis.

Abstract

Aim: This review aims to synthesise the newest literature to determine the effectiveness of Motivational Interviewing (MI) interventions for clinical and non-clinical outcomes in Type 2 Diabetes Mellitus (T2DM) patients 18 years old and above. Methods: An electronic search was conducted through seven bibliographical databases, trial registries and reference lists until 5 February 2021. Then, individual study bias was assessed using the latest version of Cochrane risk-of-bias (RoB 1) tool. At the end, the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) tool was used as a framework to summarise overall evidence and provide recommendations for clinical practice. Meta-analyses were performed with Review Manager software Version 5.4. Z-statistics were used to evaluate the overall effect of MI interventions while I2 was used to check heterogeneity of the articles. Subgroup analyses were used for additional meta-analyses. Results: Out of the initial 285 studies screened for eligibility, only 6 RCTs were retained. More than half of the studies (58%) had a low risk of bias across six domains. The overall quality of evidence for glycated haemoglobin (HbA1c) outcome was moderate according to GRADE criteria, and very low evidence for BMI outcome. Meta-analyses revealed that T2DM patients who underwent MI intervention had significant improvement in HbA1c outcomes, but no change in BMI and cholesterol levels. Subgroup analyses suggested that MI training conducted face to face is more effective as compared to telephone-delivered MI. Patients in MI groups were also better motivated to change behaviours, as seen in better PEI scores, and showed more satisfaction in treatment observed by better DTSQ scores. They also obtained greater self-efficacy in disease management after going through MI interventions, as reflected by greater scores in the Sherer’s self-efficacy scale. Lastly, MI group patients have lower PAID scores, which suggests that they possibly experienced less distress as compared to their usual care counterparts. Conclusion: Even though MI principles are technical and useful, there is undeniably a huge variation in the MI intervention structures. Hence, evidence proving effectiveness of MI outcomes in T2DM patients may be weak. More quality Randomised Controlled Trials (RCT)s with large sample size are needed to investigate how MI principles can be easily incorporated into clinical practice.