Reducing Diabetes Distress in Adults With T1D: A Comparison of 2 Interventions

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Educational/behavioral and emotion-focused approaches may reduce diabetes distress in patients with high HbA1c.
Educational/behavioral and emotion-focused approaches may reduce diabetes distress in patients with high HbA1c.

Diabetes distress in adults with type 1 diabetes can be significantly reduced through either an educational/behavioral or emotion-focused approach, according to a study published in Diabetes Care.

The randomized controlled trial was conducted to compare the efficacy of 2 interventions geared toward reducing diabetes distress and improving glycemic control in adults with type 1 diabetes. Researchers assigned 301 patients (mean age, 45.1 years) with elevated diabetes distress and HbA1c to OnTrack (n=152), an emotion-focused intervention, or KnowIt (n=149), an educational/behavioral intervention. Participants in each group attended a full-day workshop in addition to 4 online over the course of 3 months.

Researchers assessed patients at baseline and after 3 and 9 months for changes in diabetes distress and hypoglycemia distress. For diabetes distress, they discovered dramatic reductions in both groups, with 78.4% of the total population experiencing a reduction of at least 1 minimal clinically important difference after 9 months. Furthermore, change in diabetes distress was deemed modestly associated with change in HbA1c (P =.01).

In regard to hypoglycemia distress, researchers discovered modest reductions in HbA1c levels between baseline and 3 months (P =.003). These levels were largely sustained at 9 months. No significant differences were found between the groups during any period.

Compared with KnowIt, OnTrack was found to provide greater reduction in diabetes distress to those with initially poorer cognitive or emotion regulation skills, higher baseline diabetes distress, or greater initial diabetes knowledge.

Researchers noted several limitations to this study, such as an inability to follow up with participants who were randomized but did not attend the required workshop.

Despite this and other limitations, researchers said their findings "point to the importance of tailoring interventions to address affective, knowledge, and cognitive skills when intervening to reduce [diabetes distress] and improve glycemic control."

Reference

Fisher L, Hessler D, Polonsky WH, et al. T1-REDEEM: A randomized controlled trial to reduce diabetes distress among adults with type 1 diabetes [published online July 5, 2018]. Diabetes Care. doi: 0.2337/dc18-0391

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