A case series of CBT-inspired behavioral and medical interventions for uncontrolled type 2 diabetes

Type 2 diabetes mellitus (T2DM) is a global health challenge often complicated by poor treatment adherence, suboptimal lifestyle habits, and progressive metabolic deterioration. Cognitive behavioral therapy (CBT) has been shown to improve adherence and psychological outcomes, yet its integration with structured lifestyle modification and pharmacotherapy in routine clinical care remains underexplored. A descriptive case series of five patients with uncontrolled T2DM (baseline HbA1c 11–14.5%) was conducted in a primary care setting in Palestine. The intervention combined CBT-inspired behavioral counseling (goal setting, problem-solving, cognitive restructuring) with a structured two-meal low-carbohydrate diet, exercise and sleep hygiene guidance, and pharmacotherapy optimization (withdrawal of insulin/sulfonylureas, initiation of metformin, DPP-4 inhibitors, and SGLT2 inhibitors as appropriate). Patients were followed for 3–6 months. All five patients achieved clinically meaningful improvements. Mean HbA1c decreased from 12.6% at baseline to 7.4% at follow-up. Weight loss ranged from 5–17 kg (mean ~10 kg). Additional benefits included reductions in blood pressure, improvements in renal function and lipid profiles, and resolution of quality-of-life issues such as fatigue and erectile dysfunction. Several patients discontinued insulin or sulfonylurea therapy while maintaining improved glycemic control. The integration of CBT-inspired counseling with structured lifestyle intervention and pharmacotherapy adjustments was associated with short-term improvements in uncontrolled T2DM, including outcomes approaching remission. Although the small sample size and uncontrolled design limit causal interpretation, the program is being done in a low-income, limited-resources area like Palestine. Patients do not have the privilege to attend and receive care from several healthcare professionals. Hence, conducting such practice in a primary care clinic and yielding such results and improvement in diabetes status is promising and provides hope to the patients with low income.