How does addressing diabetes distress lead to positive glycemic change? Results from the EMBARK trial

Authors: Lawrence Fisher, Susan Guzman, William H Polonsky, Lisa Strycker, Katherine Greenberg, Danielle M Hessler

Abstract

Objective: To document the effectiveness of diabetes distress (DD) interventions and to suggest how the improvements in DD, documented in a previous report, led to improved glycemic outcomes.

Methods: Individuals with T1D (n = 276) with elevated DD (>2 on T1 Diabetes Distress Scale) and HbA1c (>7.5 %) were assigned to: (1) StreamLine, a diabetes self-management program; (2) TunedIn, an ACT-based (Acceptance and Commitment Therapy), emotion-focused DD program; or (3) FixIt, an integration of Streamline and TunedIn. Previous research had shown reduced DD (Stage 1) and improved glycemic outcomes (Stage 4) from baseline to 12-months. Here we assess two intermediate stages: adoption of a new emotional perspective (Stage 2) and improvements in diabetes-related problem solving (Stage 3). A structural equation model was specified to evaluate a hypothesized, 4-stage model of change.

Results: Improvements occurred in all three interventions at all 4 stages. TunedIn and FixIt, however, compared to StreamLine, displayed greater improvements in Stages 1 through 3; while StreamLine and TunedIn displayed greater improvements in glycemic outcomes than FixIt. Associations between reductions in DD and glycemic change were explained through improvements in emotional perspective taking and problem solving.

Conclusion: Although all three intervention groups showed improvement, TunedIn demonstrated the most comprehensive benefits. Findings indicate how reductions in diabetes distress, documented in a previous report, are linked with improved glycemic outcomes through changes in emotional perspective-taking, which then allow for improved diabetes-related problem solving. This sequence can form the basis for designing effective intervention programs to reduce DD and improve overall diabetes management.

Keywords: Diabetes distress; Glycemic outcomes; Mechanisms of change.

Source: https://pubmed.ncbi.nlm.nih.gov/40441551/

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BDI Monthly Events

June 5 - 8: It will be a busy time at the American Diabetes Association’s 85th Scientific Sessions (New Orleans, LA), with new projects to be developed, old friends to see, and much to learn. Dr. Polonsky, BDI President, will serve a co-author on four poster presentations

May 13: BDI hosts the San Diego-wide, monthly case consultation meeting (for mental health professionals working in the field of diabetes). Contact us at [email protected] if you are in the greater San Diego area and would like further information about this program.

August 14 - 16. Taking Control of Your Diabetes (TCOYD) will be hosting the in-person ONE event, an amazing weekend experience here in San Diego for more than 500 people with type 1 diabetes and their loved ones. Dr. Polonsky is honored to be one of the presenters, and we will hope to see many of you there. There are still a few spaces left, so if you’d like to know more, please visit

On October 24, BDI will host a live, one-day, CME workshop: Engaging the Disengaged: Innovative Strategies for Promoting Behavior Change in Diabetes. Run by Dr. Polonsky (BDI President) and Dr. Guzman (BDI Clinic Director), Participants will deepen their skills in recognizing and addressing common barriers to effective self-care and cardiometabolic medication initiation and maintenance, while fostering respectful, stigma-free clinical encounters.