A cognitive behavior therapy-based intervention among poorly controlled adult type 1 diabetes patients-A randomized controlled trial

Objective: To examine the impact of a Cognitive Behavior Therapy (CBT)-based intervention on Hba(1c), self-care behaviors and psychosocial factors among poorly controlled adult type 1 diabetes patients. Methods: Ninety-four type 1 diabetes patients were randomly assigned to either an intervention group or a control group. The intervention was based on CBT and was mainly delivered in group format, but individual sessions were also included. All subjects were provided with a continuous glucose monitoring system (CGMS) during two 3-day periods. HbA(1c), self-care behaviors and psychosocial factors were measured up to 48 weeks. Results: Significant differences were observed with respect to HbA(1c), (P < 0.05), well-being (P < 0.05), diabetes-related distress (P < 0.01), frequency of blood glucose testing (P < 0.05), avoidance of hypoglycemia (P < 0.01), perceived stress (P < 0.05), anxiety (P < 0.05) and depression (P < 0.05), all of which showed greater improvement in the intervention group compared with the control group. A significant difference (P < 0.05) was registered with respect to non-severe hypoglycemia, which yielded a higher score in the intervention group. Conclusion: This CBT-based intervention appears to be a promising approach to diabetes self-management. Practice implications: Diabetes care may benefit from applying tools commonly used in CBT. For further scientific evaluation in clinical practice, there is a need for specially educated diabetes care teams, trained in the current approach, as well as cooperation between diabetes care teams and psychologists trained in CBT. (C) 2009 Elsevier Ireland Ltd. All rights reserved.