T1-REDEEM: A Randomized Controlled Trial to Reduce Diabetes Distress Among Adults With Type 1 Diabetes

被引:79
作者
Fisher, Lawrence [1 ]
Hessler, Danielle [1 ]
Polonsky, William H. [2 ]
Masharani, Umesh [1 ]
Guzman, Susan [3 ]
Bowyer, Vicky [1 ]
Strycker, Lisa [4 ]
Ahmann, Andrew [5 ]
Basina, Marina [6 ]
Blumer, Ian [7 ]
Chloe, Charles [8 ]
Kim, Sarah [1 ]
Peters, Anne L. [9 ]
Shumway, Martha [1 ]
Weihs, Karen [10 ]
Wu, Patricia [11 ]
机构
[1] Univ Calif San Francisco, San Francisco, CA 94143 USA
[2] Univ Calif San Diego, San Diego, CA 92103 USA
[3] Behav Diabet Inst, San Diego, CA USA
[4] Oregon Res Inst, Eugene, OR 97403 USA
[5] Oregon Hlth & Sci Univ, Portland, OR 97201 USA
[6] Stanford Univ, Stanford, CA 94305 USA
[7] Univ Toronto, Toronto, ON, Canada
[8] Univ Calif San Diego, Vet Affairs San Diego Healthcare Syst, San Diego, CA 92103 USA
[9] Univ Southern Calif, Keck Sch Med, Los Angeles, CA 90033 USA
[10] Univ Arizona, Coll Med, Tucson, AZ USA
[11] Kaiser Permanente Med Grp, San Diego, CA USA
关键词
SELF-REGULATION; REGIMEN DISTRESS; DEPRESSION; MANAGEMENT; TIME;
D O I
10.2337/dc18-0391
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
OBJECTIVETo compare the effectiveness of two interventions to reduce diabetes distress (DD) and improve glycemic control among adults with type 1 diabetes (T1D).RESEARCH DESIGN AND METHODSIndividuals with T1D (n = 301) with elevated DD and HbA(1c) were recruited from multiple settings and randomly assigned to OnTrack, an emotion-focused intervention, or to KnowIt, an educational/behavioral intervention. Each group attended a full-day workshop plus four online meetings over 3 months. Assessments occurred at baseline and 3 and 9 months. Primary and secondary outcomes were change in DD and change in HbA(1c), respectively.RESULTSWith 12% attrition, both groups demonstrated dramatic reductions in DD (effect size d = 1.06; 78.4% demonstrated a reduction of at least one minimal clinically important difference). There were, however, no significant differences in DD reduction between OnTrack and KnowIt. Moderator analyses indicated that OnTrack provided greater DD reduction to those with initially poorer cognitive or emotion regulation skills, higher baseline DD, or greater initial diabetes knowledge than those in KnowIt. Significant but modest reductions in HbA(1c) occurred with no between-group differences. Change in DD was modestly associated with change in HbA(1c) (r = 0.14, P = 0.01), with no significant between-group differences.CONCLUSIONSDD can be successfully reduced among distressed individuals with T1D with elevated HbA(1c) using both education/behavioral and emotion-focused approaches. Reductions in DD are only modestly associated with reductions in HbA(1c). These findings point to the importance of tailoring interventions to address affective, knowledge, and cognitive skills when intervening to reduce DD and improve glycemic control.
引用
收藏
页码:1862 / 1869
页数:8
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