Behavioral Interventions in Pediatric Type 1 Diabetes Management: An Updated Meta-Analysis.

CONTEXT: The last meta-analysis of behavioral interventions regarding pediatric type 1 diabetes (T1D) management was conducted over a decade ago. OBJECTIVE: This meta-analysis aimed to (1) provide an updated review of adherence-promoting behavioral interventions and their effect on youths' hemoglobin A1C (HbA1C) and (2) evaluate whether multicomponent interventions targeting both direct and indirect processes of T1D management continue to yield greater HbA1C improvements. DATA SOURCES: We conducted a systematic search in PubMed and Scopus for articles published between April 2009 and February 2025. STUDY SELECTION: Included studies were randomized controlled trials (RCTs) evaluating behavioral interventions targeting T1D self-management in youth and young adults up to age 25 years. DATA EXTRACTION: Extracted data included study characteristics, intervention content and duration, and glycemic outcomes for intervention and comparison groups. RESULTS: Of the 62 RCTs identified, 46 reported sufficient data for quantitative analysis. The pooled effect size demonstrated a small benefit of adherence-promoting interventions on HbA1C (g = 0.12). Pilot RCTs showed larger effects (g = 0.36) than full RCTs (g = 0.07). Multicomponent interventions yielded greater improvements (g = 0.19) than direct (g = 0.08) or indirect (g = 0.15) interventions. Family-focused interventions demonstrated stronger effects (g = 0.29) than youth- (g = 0.05) or parent-focused (g = 0.04) interventions. LIMITATIONS: Findings are limited to published RCTs. CONCLUSIONS: Despite significant advancements in diabetes technology over the last decade, behavioral interventions continue to modestly improve HbA1C in youth with T1D. Multicomponent, family-focused strategies appear to be most effective. Findings highlight the need for rigorous trial designs to advance care for youth living with T1D. ARTICLE SUMMARY: Updated meta-analysis shows behavioral interventions modestly improve HbA1C in youth with T1D, with multicomponent, family-focused approaches outperforming single-component, youth- or parent-focused strategies overall.