Cognitive behavioral therapy-based intervention reduces diabetes distress for adults
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A cognitive behavioral therapy multidisciplinary intervention was associated with a reduction in HbA1c and improvements in diabetes distress for adults with type 1 and type 2 diabetes, according to study findings.
In a study published in The Science of Diabetes Self-Management and Care, researchers enrolled 29 adults with diabetes into the Diabetes Tune-Up Group, a multidisciplinary group intervention designed to deliver integrated psychoeducational, cognitive, motivational and emotional interventions in a scalable manner across six sessions. Participants in the intervention not only had a reduction in diabetes distress by the end of the final session, but diabetes distress also further improved 3 months after the intervention concluded.
“This study demonstrated the feasibility and positive outcomes of a diabetes distress and adherence support intervention delivered by diabetes care and education specialists and behavioral health professionals that is designed for scalability in diabetes centers to support the delivery of integrated patient care,” Mary de Groot, PhD, associate professor of medicine and acting director of the Diabetes Translational Research Center at Indiana University, and colleagues wrote. “Future studies will focus on adapting and providing the intervention to larger groups of patients with diabetes using flexible virtual formats to demonstrate efficacy and generalizability on a larger scale.”
From March 2018 to May 2019, researchers recruited adults aged 21 years and older with type 1 or type 2 diabetes for at least 1 year, an HbA1c of 8% or higher and a Diabetes Distress Scale score of 2.5 or higher, indicating at least a moderate level of distress. The intervention consisted of six group sessions stratified by diabetes type, with a maximum of 10 participants in each group. Each session included psychoeducation, group discussion and a take-home assignment to be completed before the next session. A 17-item version of the Diabetes Distress Scale was administered, with a score of 2 to 2.9 indicating moderate distress and a score of 3 or high indicating high distress. An adapted version of the Michigan Diabetes Knowledge Test was used to assess diabetes knowledge, the Patient Health Questionnaire was used to assess depression, and diabetes self-efficacy was measured using the Confidence in Diabetes Self-Care questionnaire. All of the questionnaires were conducted at baseline before the first session, at the end of the final session and 3 months after the final session. Participants completed a satisfaction form at the end of the intervention. HbA1c was measured at all time points.
There were 41 adults screened for eligibility, of whom 29 enrolled in the intervention (mean age, 55.9 years; 79% women; 59% white). Of the cohort, 86.2% completed the post-intervention follow-up and 65.5% completed the 3-month follow-up. The cohort included 21 adults with type 2 diabetes and eight with type 1 diabetes.
Intervention linked to lower HbA1c
The cohort had a mean decrease in HbA1c of 0.44% from baseline to the final follow-up. Diabetes Distress Scale scores decreased from a mean of 3.44 at baseline to 2.94 at the end of the intervention and 2.55 at 3 months (P < .001 for both). Depressive symptoms decreased from baseline to the end of the intervention and 3 months. Participants had improvements in diabetes self-efficacy from baseline to the final session (P = .016) and at 3 months (P < .001). Health-related quality of life scores improved from baseline to post-intervention (P = .014) and at 3 months (P = .018).
On the satisfaction survey, all participants reported being at least somewhat to very satisfied by all aspects of the intervention. The mean score for satisfaction was 4.59 on a 5-point Likert scale.
Less diabetes distress in type 1 and type 2 diabetes
After stratifying by diabetes type, a decrease in mean HbA1c was not observed for participants with type 1 or type 2 diabetes, though the researchers attributed that to the study’s small sample size. The type 2 diabetes group had a decrease in diabetes distress from baseline to the final session and 3-month follow-up, whereas a significant improvement in diabetes distress among those with type 1 diabetes was only observed from baseline to 3 months.
“An approach that leverages the expertise of a multidisciplinary team and equips diabetes care and education specialist professionals with the full range of intervention tools is important to improve diabetes distress and HbA1c,” the researchers wrote. “Future research is needed to establish the comparative effectiveness of this approach to treatment approaches currently in practice.”
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