Motivational interventions in the management of HbA1c levels: A systematic review and meta-analysis

Published:February 12, 2014DOI:



      To review the diabetes literature in order to examine the effect of motivational interventions on treatment outcome as measured by changes in glycated haemoglobin.


      Relevant databases were systematically searched for randomised controlled trials in which motivational interventions were examined in relation to treatment outcome in people with type 1 and type 2 diabetes mellitus.


      The 13 studies identified for review included 1223 participants diagnosed with type 1 diabetes and 1895 participants diagnosed with type 2 diabetes. The analysis showed a 0.17% (95% CI: −0.09, 0.43%) improvement in glycemic control in people who received a motivational intervention compared to a control group, however, the effect was not statistically significant.


      The impact of motivational interventions in the management of blood glucose levels appears to be limited. However, due to the small number of studies and issues of heterogeneity caution in interpreting the present findings is advised. Moreover, the unique contribution of motivational interventions may be better assessed by outcomes such as behaviour change and other intermediate outcomes. Further research examining the delivery and focus of motivational interventions in helping people manage their diabetes is recommended. The clinical implications of the present findings are therefore uncertain pending further research.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Primary Care Diabetes
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Whiting D.R.
        • Guariguata L.
        • Weil C.
        • Shawd J.
        IDF Diabetes Atlas: global estimates of the prevalence of diabetes for 2011 and 2030.
        Diabetes Res. Clin. Pract. 2011; 94: 311-321
        • Rollnick S.
        • Kinnersley P.
        • Stott N.
        Methods of helping patients with behaviour change.
        BMJ. 1993; 307: 188-190
        • Miller W.R.
        • Rollnick S.
        Motivational Interviewing Helping People Change.
        3rd ed. Guilford Press, New York2013
        • Rubak S.
        • Sandbaek A.
        • Lauritzen T.
        • Christensen B.
        Motivational interviewing: a systemic review and meta-analysis.
        Brit. J. Gen. Pract. 2005; 55: 305-313
        • Martins R.K.
        • McNeil D.W.
        Review of motivational interviewing in promoting health behaviors.
        Clin. Psychol. Rev. 2009; 29: 283-293
        • Knowles L.
        • Anokhina A.
        • Serpell L.
        Motivational interventions in the eating disorders: what is the evidence?.
        Int. J. Eat. Disord. 2012; 46: 97-107
        • Waller G.
        The myths of motivation: time for a fresh look at some received wisdom in the eating disorders?.
        Int. J. Eat. Disord. 2012; 45: 1-16
        • UK Prospective Diabetes Study (UKPDS) Group
        Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33).
        Lancet. 1998; 352: 837-853
        • Nathan D.M.
        • Cleary P.A.
        • Backlund J.Y.
        • et al.
        • (DCCT/EDIC) Study Research Group
        Intensive diabetes treatment and cardiovascular disease in patients with type 1 diabetes.
        N. Engl. J. Med. 2005; 353: 2643-2653
        • Miller W.R.
        Motivational interviewing with problem drinkers.
        Behav. Psychother. 1983; 11: 147-172
        • Brug J.
        • Spikmans F.
        • Aartsen C.
        • et al.
        Training dietitians in basic motivational interviewing skills results in changes in their counseling style and in lower saturated fat intakes in their patients.
        J. Nutr. Educ. Behav. 2007; 39: 8-12
        • Channon S.J.
        • Huws-Thomas M.V.
        • Rollnick S.
        • et al.
        A multicenter randomized controlled trial of motivational interviewing in teenagers with diabetes.
        Diabetes Care. 2007; 30: 1390-1395
        • Chen S.M.
        • Creedy D.
        • Lin H.S.
        • Wollin J.
        Effects of motivational interviewing intervention on self-management, psychological and glycemic outcomes in type 2 diabetes: a randomised controlled trial.
        Int. J. Nurs. Stud. 2012; 49: 637-644
        • Hawkins S.Y.
        Improving glycemic control in older adults using a videophone motivational diabetes self-management intervention.
        Res. Theory Nurs. Pract.: Int. J. 2010; 24: 217-232
        • Ismail K.
        • Maissi E.
        • Thomas S.
        • et al.
        A randomised controlled trial of cognitive behaviour therapy and motivational interviewing for people with type 1 diabetes mellitus with persistent sub-optimal glycaemic control: a Diabetes and Psychological Therapies (ADaPT) study.
        Health Technology Assessment. 2010; 14 (No. 22)
        • Minet L.K.R.
        • Wagner L.
        • Lønvig M.
        • et al.
        The effect of motivational interviewing on glycaemic control and perceived competence of diabetes self-management in patients with type 1 and type 2 diabetes mellitus after attending a group education programme: a randomised controlled trial.
        Diabetologia. 2011; 54: 1620-1629
        • Partapsingh V.A.
        • Maharaj R.G.
        • Rawlins J.M.
        Applying the stages of change model to type 2 diabetes care in Trinidad: a randomised trial.
        J. Negat. Results Biomed. 2011; 10: 1-8
        • Pill R.
        • Stott N.C.H.
        • Rollnick S.R.
        • Rees M.
        A randomized controlled trial of an intervention designed to improve the care given in general practice to Type II diabetes patients: patient outcomes and professional ability to change behaviour.
        Fam. Pract. 1998; 15: 229-235
        • Robling M.
        • McNamara R.
        • Butler C.C.
        • et al.
        The effect of the talking diabetes consulting skills intervention on glycaemic control and quality of life in children with type 1 diabetes: cluster randomised controlled trial (DEPICTED study).
        BMJ. 2012; 344: e2359
        • Rubak S.
        • Sandbæk A.
        • Lauritzen T.
        • et al.
        Effect of motivational interviewing on quality of care measures in screen detected type 2 diabetes patients: a one-year follow-up of an RCT, ADDITION Denmark.
        Scand. J. Prim. Health Care. 2011; 29: 92-98
        • Wang Y.C.
        • Stewart S.M.
        • Mackenzie M.
        • et al.
        A randomized controlled trial comparing motivational inter viewing in education to structured diabetes education in teens with type 1 diabetes.
        Diabetes Care. 2010; 33: 1741-1743
        • Welch G.
        • Zagarins S.E.
        • Feinberg R.G.
        • Garb J.L.
        Motivational interviewing delivered by diabetes educators: does it improve blood glucose control among poorly controlled type 2 diabetes patients?.
        Diabetes Res. Clin. Pract. 2011; 91: 54-60
        • West D.S.
        • DiLillo V.
        • Bursac Z.
        Motivational interviewing improves weight loss in women with type 2 diabetes.
        Diabetes Care. 2007; 30: 1081-1087
      1. Higgins J.P.T. Green S. Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011 (available from
        • Minet L.
        • Moller S.
        • Vach W.
        • et al.
        Mediating the effect of self-care management intervention in type 2 diabetes: a meta-analysis of 47 randomised controlled trials.
        Patient Educ. Couns. 2010; 80: 29-4127