Mediating factors between diabetes distress, glycemic outcomes identified
medwireNews: Improved diabetes knowledge and reduced distress both contribute to the positive effects of diabetes distress interventions on glycemic outcomes, say researchers.
Presenting the data at the virtual ADA 80th Scientific Sessions, Danielle Hessler (University of California, San Francisco, USA) commented that although it is well established that diabetes distress impacts glycemic outcomes, the factors that mediate this relationship are less clear.
“This lack of knowledge has been hampering some of our abilities to intervene and refine our interventions,” she said.
The research team addressed this using data from a randomized trial of two diabetes distress interventions in 301 adults with type 1 diabetes, who had an average age of 45 years, Type 1 Diabetes Distress Scale score of 2.9, and glycated hemoglobin (HbA1c) of 8.8% (73 mmol/mol).
Hessler explained that one intervention (KnowIt) addressed education to improve diabetes self-management, and the other (OnTrack) was an affective intervention, which directly addressed diabetes distress by helping people to understand the emotional side of diabetes and develop emotion-management techniques, “to get unstuck about behavior changes.”
Both interventions eased diabetes distress, which led to improvements in missed insulin boluses, problem solving, ability to adjust insulin according to diet, blood glucose self-monitoring, and diabetes knowledge.
With both interventions, the improvement in missed boluses was directly associated with improved HbA1c, and the increased frequency of blood glucose monitoring with reduced hypoglycemia.
But only the affective intervention led to reduced hypoglycemia via improved problem solving and diabetes knowledge.
Introduction of continuous glucose monitoring (CGM) also reduced diabetes management distress, and had direct effects on missed insulin boluses and HbA1c levels. But the effects of the two interventions were independent of the influence of CGM.
Moreover, Hessler said that the associations were overall stronger for the affective intervention than the educational intervention, “supporting the importance of integrating interventions aimed at reducing diabetes distress with disease management to maximize improvements in glycemic control.”
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