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.

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.