OBJECTIVEThis study evaluated the effect of cognitive behavioral therapy (CBT) plus lifestyle counseling in primary care on hemoglobin A 1c (HbA 1c ) in rural adult patients with type 2 diabetes (T2D) and comorbid depressive or regimen-related distress (RRD) symptoms. RESEARCH DESIGN AND METHODSThis study was a randomized controlled trial of a 16-session severity-tailored CBT plus lifestyle counseling intervention compared with usual care. Outcomes included changes in HbA 1c , RRD, depressive symptoms, self-care behaviors, and medication adherence across 12 months. RESULTSPatients included 139 diverse, rural adults (mean age 52.6 6 9.5 years; 72% black; BMI 37.0 6 9.0 kg/m 2 ) with T2D (mean HbA 1c 9.6% [81 mmol/mol] 6 2.0%) and comorbid depressive or distress symptoms. Using intent-to-treat analyses, patients in the intervention experienced marginally significant improvements in HbA 1c (20.92 6 1.81 vs. 20.31 6 2.04; P = 0.06) compared with usual care. However, intervention patients experienced significantly greater improvements in RRD (21.12 6 1.05 vs. 20.31 6 1.22; P = 0.001), depressive symptoms (23.39 6 5.00 vs. 20.90 6 6.17; P = 0.01), self-care behaviors (1.10 6 1.30 vs. 0.58 6 1.45; P = 0.03), and medication adherence (1.00 6 2.0 vs. 0.17 6 1.0; P = 0.02) versus usual care. Improvement in HbA 1c correlated with improvement in RRD (r = 0.3; P = 0.0001) and adherence (r = 20.23; P = 0.007). CONCLUSIONSTailored CBT with lifestyle counseling improves behavioral outcomes and may improve HbA 1c in rural patients with T2D and comorbid depressive and/or RRD symptoms.

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Previous research suggests that individuals diagnosed with eating disorders (ED) may experience executive functioning deficits that help maintain their ED. Although this relationship is reported consistently in clinical samples, it is important to consider whether it holds for individuals with sub-clinical ED symptoms. One hundred eighty-eight university students participated in the present study examining the relationship between executive function (EF) and disordered eating behaviors. Participants completed a demographics questionnaire, self-report questionnaires measuring atypical eating behaviors (EAT-26; EDI-3), and a self-report measure of EF (BRIEF-A). Correlational analyses demonstrated significant positive associations between ED behaviors and problems with emotional control, shifting, inhibition, and self-monitoring. Six hierarchical multiple regressions were conducted, using EF scores to predict scores on EAT-26 subscales (Dieting, Bulimia, Total ED Risk) and EDI-3 scales (Drive for Thinness, Bulimia, Risk Composite). In all regression analyses, BRIEF-A Emotional Control emerged as a significant predictor. As would be expected, EDI-3 Bulimia scores were also predicted by problems with inhibition. These results provide preliminary evidence of an association between non-clinical patterns of disordered eating and executive dysfunction, specifically including the ability to control one’s emotions, suggesting that emotional control problems may help predict ED risk. Future research could examine how these factors predict the development of eating disorders.

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