Different approaches have equal impact for the reduction of diabetes distress
medwireNews: Both emotion-focused and educational–behavioral interventions substantially reduce diabetes distress in patients with type 1 diabetes, results of the T1-REDEEM study show.
Furthermore, the improvements in diabetes distress were sustained for at least 9 months and did not differ according to the type of intervention used, report Lawrence Fisher (University of California, San Francisco, USA) and colleagues in Diabetes Care.
The lack of difference between the two interventions was unexpected, but may be due, in part, to the “sense of community” experienced by both groups, say the researchers, adding that post-study interviews suggested that the participants found the interaction with other adults with type 1 diabetes helped to normalize their experiences of diabetes.
“We suggest that the power of the group experience, in which personal sharing and interaction are encouraged by expert, sensitive group leadership, can have dramatic [diabetes distress]-reduction effects for distressed adults with [type 1 diabetes],” Fisher and co-authors remark.
For the study, 301 individuals (mean age 45 years, 69% women) with type 1 diabetes, elevated diabetes distress (mean item score of 2.9 on the Type 1 Diabetes Distress Scale), and raised glycated hemoglobin (HbA1c; mean 8.8%) were randomly assigned to take part in OnTrack, an emotion-focused intervention, or KnowIt, an educational–behavioral intervention.
The researchers explain that OnTrack focuses on improving emotion regulation skills by using a variety of exercises to help deal with the emotional side of diabetes and develop personalized emotion management techniques to get “unstuck” regarding behavioral change. By contrast, KnowIt addresses the causes of type 1 diabetes, tips on carbohydrate counting, and the use of strategies to address specific management problems.
Each group attended a full-day workshop plus four online meetings over 3 months.
At 3 months both groups demonstrated “dramatic reductions” in diabetes distress (effect size d=1.06), with further significant improvements observed at 9 months. The majority (78.4%) of participants demonstrated a reduction of at least one minimal clinically important difference in overall diabetes distress or a subscale.
There was no significant difference between the two interventions in the size of the effect, but moderator analyses suggested that OnTrack resulted in greater improvements in diabetes distress among individuals with initially poorer cognitive or emotion-regulation skills, higher baseline diabetes distress, or greater initial diabetes knowledge than those in KnowIt.
Both interventions also resulted in significant but modest reductions of 0.09% to 0.17% in HbA1c at 3 months, which were sustained at 9 months.
Fisher et al conclude: “These findings have significant clinical implications by suggesting a variety of approaches that might be undertaken in clinical care: for example, utilization of a stepped-care approach with all individuals receiving KnowIt initially and those not responding subsequently receiving OnTrack; tailoring interventions based on earlier emotion regulation, cognitive skill, and diabetes knowledge screening; or a program of the same length that combines OnTrack and KnowIt in a meaningful way.”
By Laura Cowen
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