medwireNews: Supported problem-solving does not result in improved glycemic control in patients with type 1 diabetes, but does reduce diabetes distress, show the findings of a randomized trial.
In fact, Jannike Mohn (Western Norway University of Applied Sciences, Bergen) and co-workers found significant declines in glycated hemoglobin in both the intervention and control groups, of 0.6% (from 9.1 to 8.5%) and 0.4% (9.3 to 8.9%), respectively.
They attribute this to the observer effect, whereby “individuals modify or improve their behaviour in response to their awareness of being observed.”
The team notes that a previous randomized trial showed a positive effect of guided self-determination on glycemic control, but later studies did not, although as with the current study there were beneficial effects for outcomes such as diabetes distress.
The trial showing a positive effect on glycemic control involved 50 patients in total, making it considerably smaller than the current study, which recruited 178. However, of the 90 patients assigned to the guided self-determination group, just 48 actually completed the intervention, compared with 83 of the 88 patients who received usual care. Twenty patients withdrew after randomization and a further 13 did not attend any intervention sessions.
There were seven sessions available in total, which each lasted 2 hours and were spread over 14 weeks. The patients completed semi-structured worksheets before appointments, so they were prepared to discuss treatment barriers with the specially trained diabetes nurses supervising the sessions. Patients who did not attend these sessions had higher baseline glycated hemoglobin, more severe diabetes distress, and were less likely to have university-level education than those who did attend.
“Consistent with previous studies, targeting distressed persons with diabetes can be difficult because those with the greatest need for psychological support are most likely to drop out of the psychological intervention,” say the researchers in BMJ Open.
Nonetheless, those patients who did remain in the intervention group had significant improvements in Diabetes Distress Scale scores versus those who received usual care, both overall and for emotional burden.
They also had significant improvements on the Rosenberg Self-Esteem Scale and in autonomous motivation on the Treatment Self-Regulation Questionnaire. The researchers suggest the latter improvement may underlie the reduction in diabetes distress.
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