| Background The presence of depressive symptoms in patients with type 2 diabetes mellitus (T2DM) increases their risk of complications and adversely affects disease prognosis. As an important supplement to pharmacological treatment, non-drug interventions contribute to improving depressive symptoms among these patients. However, systematic evaluations of the effectiveness of different non-drug interventions are lacking. Objective To evaluate and compare the efficacy of seven non-drug interventions in improving depressive symptoms among patients with T2DM using network Meta-analysis and to provide evidence-based recommendations for intervention strategies. Methods We conducted a computerized search of CNKI, Wanfang Data, VIP, CBM, PubMed, Embase, EBSCO, Cochrane Library, ScienceDirect, and Web of Science databases for randomized controlled trials (RCTs) on non-drug interventions for depressive symptoms in T2DM patients, according to inclusion and exclusion criteria. The search period was from the databases' inception to November 29, 2024. Two researchers screened the literature, extracted data, and assessed the risk of bias. Data analysis was performed using Stata 17.0, with the standardized mean difference (SMD) and 95% CI as effect indicators to compare the effectiveness among interventions and rank them. Results A total of 55 studies were included, involving 9,144 patients with type 2 diabetes and examining seven types of non-drug interventions, were included in the analysis. The results of the network Meta-analysis revealed that compared with the conventional intervention group, acupuncture therapy (SMD=-1.25, 95% CI: -1.72~-0.78), comprehensive nursing intervention (SMD=-1.13, 95% CI: -1.45~-0.82), relaxation therapy (SMD=-1.15, 95% CI: -1.82~-0.48), mindfulness-based therapy (SMD=-1.02, 95% CI: -1.61~-0.44), cognitive-behavioral therapy (SMD=-0.62, 95% CI: -0.87~-0.37), exercise therapy (SMD=-0.61, 95% CI: -0.99~-0.22), and health education (SMD=-0.60, 95% CI: -0.94~-0.25) (all P<0.05). Regarding their effectiveness, the surface under the cumulative ranking (SUCRA) ranked the interventions from highest to lowest: acupuncture therapy, comprehensive nursing intervention, relaxation therapy, mindfulness-based therapy, cognitive-behavioral therapy, exercise therapy, and health education. Conclusion Acupuncture therapy was the most effective among the seven non-drug interventions in alleviating depressive symptoms in patients with type 2 diabetes mellitus, followed by comprehensive nursing interventions and relaxation therapy. |