Tele–Cognitive Behavioral Therapy for the Treatment of Diabetes-Related Distress in Individuals With Diabetes Mellitus: Systematic Review and Meta-Analysis of Randomized Controlled Trials

Background: Diabetes-related distress (DD) is highly prevalent among individuals with diabetes mellitus (DM), significantly impacting their quality of life. Tele-Cognitive Behavioral Therapy (Tele-CBT) has demonstrated potential in reducing psychological distress among DM individuals. Notably, however, previous research has predominantly focused on in-person CBT, leaving the efficacy of Tele-CBT for managing DM-related psychological symptoms insufficiently characterized. Objective: This study aims to review the application of Tele-CBT for psychological distress in individuals with DM and evaluate its effects on DD, severity of depressive and anxiety symptoms, and hemoglobin A1c (HbA1c) levels. Methods: Electronic searches were conducted in PubMed, Embase, Web of Science, Cochrane Library, and PsycINFO for randomized controlled trials (RCTs) evaluating Tele-CBT interventions in individuals with DM. The search scope spanned from database inception to May 2025. Literature screening, data extraction, and methodological quality assessment were independently performed by two reviewers. Standardized mean differences (SMD) were used to quantify relative treatment effects, with data analyzed using Stata (version 17.0). This protocol was prospectively registered in PROSPERO (CRD420251066506). Results: A total of 11 studies involving 2,186 participants were included. Meta-analysis revealed that DM individuals receiving Tele-CBT exhibited significantly lower post-intervention scores in DD [SMD = -0.34, 95% CI (-0.55 to -0.12), P < 0.001], depression [SMD = -0.66, 95% CI (-1.01 to -0.31), P < 0.001], anxiety [SMD = -0.26, 95% CI (-0.63 to 0.12), P = 0.022], and HbA1c levels [SMD = -0.13, 95% CI (-0.26 to -0.00), P = 0.74] compared to controls. Subgroup analyses by intervention duration and guidance type were performed for DD and depression outcomes. Results indicated that professionally guided Tele-CBT was more effective than self-guided approaches in reducing DD [SMD = -0.42, 95% CI (-0.57 to -0.26), P < 0.183] and depression [SMD = -0.76, 95% CI (-1.03 to -0.50), P = 0.001]. Interventions ≤8 weeks showed greater improvements in DD [SMD = -0.51, 95% CI (-0.69 to -0.34), P = 0.892] and depression [SMD = -0.87, 95% CI (-1.21 to -0.53), P = 0.039] than those >8 weeks. Conclusions: Tele-CBT represents a cost-effective and efficacious intervention for ameliorating psychological distress and HbA1c levels in DM individuals, serving as a viable alternative to in-person CBT. However, findings should be interpreted with caution due to limited study numbers, warranting further high-quality research to validate these results. Clinical Trial: This protocol was prospectively registered in PROSPERO (CRD420251066506).