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

November 11: BDI hosts the San Diego-wide, monthly case consultation meeting (for mental health professionals working in the field of diabetes). Contact us at info@behavioraldiabetes.org if you are in the greater San Diego area and would like further information about this program.

November 14: World Diabetes Day! Time for another T1D meet-up! GrownupT1Ds, a wonderful nonprofit that organizes fun social events for adults with type 1 diabetes here in southern California and now spreading to other cities across the United States. The next local one will be at Brewery X, 3191 E. La Palma Ave., Anaheim, CA 92806. Things get started at 2:00 P.M. Please RSVP at kelly@grownup.t1ds.org

This Thanksgiving, we are especially grateful for the individuals, families, healthcare professionals, and friends who make up the BDI community. Thank you for your continued support and for sharing in our mission to improve the emotional well-being of people living with diabetes. Wishing you and your loved ones a warm and happy Thanksgiving!

November 3: Dr. Polonsky (BDI President) will be speaking on “Engaging the Disengaged: Diabetes Distress, Diabetes Burnout and More” at the Southern California Permanente Medical Group’s 32th Annual Diabetes Hybrid Symposium, in Long Beach (CA).