Behavioral Activation for Depression and Glycemic Control in Type 2 Diabetes: A Systematic Review and Meta‐Analysis

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INTRODUCTION: Depression in type 2 diabetes mellitus (T2DM) hinders self-management and glycemic control. Behavioral activation (BA), by increasing participation in positive activities, holds promise for simultaneously improving depressive symptoms and diabetes outcomes. OBJECTIVE: This study evaluated the effects of BA or BA-based interventions on depressive symptoms, glycated hemoglobin (HbA1c), diabetes self-efficacy, and self-management behaviors in adults with T2DM, and summarized their implementation characteristics. METHODOLOGY: PubMed, Web of Science, Embase, Cochrane Library, PsycINFO, CNKI, VIP, and Wanfang Data were searched from inception to February 1, 2026. Interventional studies assessing BA or BA-based interventions in adults with T2DM and reporting at least one prespecified outcome were included. Quantitative meta-analyses were restricted to randomized controlled trials (RCTs) and conducted using random-effects models. Implementation characteristics from all included studies were narratively synthesized. RESULTS: Six studies involving 252 participants met the inclusion criteria, including five RCTs and one single-arm pre-post study. The meta-analysis suggested a reduction in depressive symptoms (SMD = -0.81, 95% CI: -1.22 to -0.41, p < 0.001), but no statistically significant effects on HbA1c (MD = -0.04%, 95% CI: -0.30 to 0.22, p = 0.76), diabetes self-efficacy (SMD = 0.03, 95% CI: -0.30 to 0.35, p = 0.87), or self-management behaviors (SMD = 0.04, 95% CI: -0.23 to 0.32, p = 0.77). Narrative synthesis indicated that BA interventions varied in delivery format, dosage, provider background, and integration with diabetes-specific content. Most interventions were delivered by non-mental health professionals and incorporated core BA components such as activity monitoring and goal setting. CONCLUSION: BA may reduce depressive symptoms in adults with T2DM, whereas its effects on glycemic control, diabetes self-efficacy, and self-management behaviors remain uncertain. BA has been delivered in flexible formats and may have potential for integration into diabetes care, but larger, well-powered RCTs with longer follow-up are needed to determine whether diabetes-specific BA can improve behavioral and physiological outcomes.

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