Intervention combining education, emotional focus best for reducing diabetes distress
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Key takeaways:
- Adults with type 1 diabetes had reductions in diabetes distress with three separate interventions.
- An intervention combining education and an emotional focus resulted in the greatest distress score reductions.
SAN DIEGO — Adults with type 1 diabetes may reduce diabetes distress through multiple types of interventions, with the greatest distress reductions observed in programs combining education with an emotional focus on diabetes.
In findings from the EMBARK trial presented at the American Diabetes Association Scientific Sessions, researchers analyzed data from adults with type 1 diabetes and elevated diabetes distress who participated in one of three different diabetes distress interventions. Participants in all three interventions reduced their level of diabetes distress, though an intervention that integrated an educational and emotional approach resulted in the greatest distress reductions.
“Diabetes distress is ... quite common among adults with both type 1 and type 2 diabetes,” Danielle Hessler Jones, PhD, professor of family and community medicine at the University of California, San Francisco, said during a presentation. “It’s distinct from depression. It’s associated with glycemic and disease management, including HbA1c, missed medications, missed appointments and self-management behaviors. Unfortunately, it is also chronic, and so our evidence points to it not simply disappearing on its own. It doesn’t just go away. But the good news is it’s also something that really is responsive to a range of interventions.”
The EMBARK study was a randomized controlled trial that compared three diabetes distress interventions: Streamline, which was a diabetes educator-led program focused on education and management; TunedIn, which was a psychologist-led program focusing exclusively on the emotional side of diabetes; and FixIt, which integrated elements from the Streamline and TunedIn programs. All sessions were held virtually in groups of eight to 12 adults and occurred over 3 to 4 months. Sessions included initial workshops, one-on-one phone calls and follow-up group meetings.
Researchers enrolled 300 adults aged 21 years and older with elevated diabetes distress as indicated by a score of 2 or higher on the Diabetes Distress Scale for Adults with Type 1 Diabetes (T1-DDS) and an HbA1c of 7.5% or higher (mean age, 46 years; 79% women; 89% non-Hispanic white). Participants were randomly assigned to one of the three interventions, with 101 each participating in Streamline and FixIt, and 98 participating in TunedIn. Outcomes included the total score on T1-DDS for each intervention group, score on the seven sources of diabetes distress and change in diabetes distress from baseline to after intervention.
There were reductions in diabetes distress with all three interventions, with Streamline participants having a reduction in score of 0.48 points, TunedIn participants reported a 0.59-point decrease and FixIt participants having a 0.88-point decrease. The reduction in diabetes distress for FixIt participants was greater than what was observed in Streamline (P = .005).
“The standard deviation on this scale score is 0.7 [points],” Jones said. “So these are really moderate to large effects in terms of these reductions.”
Of the cohort, 25% of Streamline participants, 36.8% of TunedIn participants and 41.8% of FixIt participants no longer had an elevated diabetes distress score of 2 or higher at follow-up. Researchers also analyzed minimal clinically important difference, which they defined as at least a 0.19-point improvement in diabetes distress score. The percentage of participants who achieved at least a 0.19-point reduction in diabetes distress score was 64.5% with Streamline, 73.7% with TunedIn and 82.3% with FixIt.
When the seven sources of distress were analyzed, the greatest reductions in distress were reported in feelings of powerlessness, followed by management, hypoglycemia and eating distress. FixIt participants had greater reductions for powerlessness, hypoglycemia and physician sources of distress than Streamline participants.
“There are multiple types of program that can successfully reduce diabetes distress in adults with type 1 diabetes,” Hessler Jones said. “We feel that these findings suggest that these distress reductions are greatest when interventions integrate education alongside a focus on the emotional side of diabetes.”
Hessler Jones said researchers plan to take a deeper dive into data from EMBARK to analyze change in HbA1c, whether a certain intervention is better for certain adults and to look at change in diabetes distress 12 months after intervention to determine whether benefits from the program continue long term.
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Hessler Jones DM. 213-OR. Presented at: American Diabetes Association Scientific Sessions; June 23-26, 2023; San Diego (hybrid meeting).
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