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

October 8: 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.

October 18: At the 2025 Annual Meeting of the Mid-Atlantic Society of Endocrinologists, in Hyattsville, MD, Dr. Polonsky (BDI President), will have the opportunity to lecture on one of his favorite topics, Diabetes Burnout. https://endoconnection.com/mid/ meetings/annual/info

October 31: Dr. Polonsky will be presenting BDI’s one day workshop, “Diabetes Turning Points: Psychosocial Challenges and Behavior Change Solutions in Diabetes”, to healthcare staff at the University of Michigan Medical School in Ann Arbor, MI. https://umich.cloud-cme.com/course/courseoverview?P=5&EID=81622