A 60-Week Prospective RCT of a Self-Management Intervention for Individuals With Serious Mental Illness and Diabetes Mellitus

Abstract

Objectives Targeted Training in Illness Management (TTIM) addresses serious mental illness and diabetes (DM) concurrently and is designed to improve psychiatric symptoms, functioning, general health and DM control. This 60-week, randomized controlled trial assessed TTIM vs. treatment as usual in 200 individuals with serious mental illness and diabetes. Methods Clinical Global Impression (CGI), Montgomery Asberg Depression Rating Scale (MADRS) and Brief Psychiatric Rating Scale (BPRS) assessed symptoms. Global Assessment of Functioning (GAF) and Sheehan Disability Scale (SDS) assessed functioning. Short-form 36 (SF-36) assessed general health and serum glycosylated hemoglobin (HbA1c) assessed DM. Results Average age was 52.7±9.5 years, 54% African-American. Psychiatric diagnoses were depression (48%), schizophrenia (25%) and bipolar disorder (28%). Baseline depressive severity was substantial while psychosis severity was modest. There was greater improvement at 60-weeks in TTIM for CGI (p=<.001) and MADRS (p=.016) and no difference on BPRS. There was greater TTIM improvement on GAF (p=.003) and an improvement trend on SDS (p=.086). There were no group differences on SF-36 or HbA1c means. Diabetes knowledge was significantly improved for TTIM vs. treatment as usual. In post-hoc analyses among individuals within recommended American Diabetes Association HbA1c targets adjusted for high comorbidity at baseline (53%), TTIM had minimal HbA1c 60-week change, while treatment as usual worsened. Conclusions TTIM was associated with improved psychiatric symptoms, functioning, and DM knowledge compared to treatment as usual. General health and DM did not significantly differ when analyzing the whole group, although there were post-hoc analysis differences among sub-groups based upon DM control at baseline.

Perceptions and experiences of living with coexisting type 2 diabetes and severe mental illness: a scoping review

“…Exploring the reasons for our search strategy's failure to identify these two studies, we found that one had actually been retrieved, but had mistakenly been excluded in the screening of titles and abstracts, probably because of its focus on comorbid anxiety [27]. The other study had probably been excluded because the abstract referred only to diabetes self-care activities as 'DM [diabetes mellitus] control' [28].…”

“…Of the four interventional studies, one aimed to test the effects of a lifestyle intervention among people with type 2 diabetes and schizophrenia [46], two tested the effects of a group-based psychosocial treatment among people with type 2 diabetes and various severe mental illnesses [27,28], and one aimed to test the effects of antidepressant medications among people with type 2 diabetes and major depression [47].…”

A 6‐month prospective randomized controlled trial of remotely delivered group format epilepsy self‐management versus waitlist control for high‐risk people with epilepsy

“…SMART is an adjunct to standard epilepsy care that is largely similar to the TIME approach and is informed by chronic disease self-management principles and techniques. [9][10][11] Consistent with community-based participatory research principles, TIME was refined with iterative input from a 13-member community advisory board (CAB) composed of individuals with epilepsy (n = 6 including one veteran), family members (n = 4), Veterans Administration and safety net clinicians (n = 2), and Prevention Research Center's Network of Community Advisors (n = 1). Mean CAB participant age was 49.6 years (SD = 10.1, range = 32-64); there were seven women and six men.…”

Targeted Self-Management of Epilepsy and Mental Illness for individuals with epilepsy and psychiatric comorbidity

“…MEW Network investigators at the Case Western Reserve University Prevention Research Center used an iterative, collaborative process to adapt an existing manualized intervention initially developed for people with serious mental illness and comorbid diabetes, [17, 18] and tested the adapted intervention, T argeted Self-Management for Ep i lepsy and Me ntal Illness (TIME) for feasibility, acceptability and preliminary efficacy in people with E-MI, using a prospective randomized controlled design comparing TIME vs. treatment as usual (TAU) over a 16-week time period in individuals with E-MI. The primary hypothesis was that at 16 weeks, TIME would be associated with greater improvement in depressive symptoms, as assessed by the Montgomery Asberg Depression Rating Scale (MADRS), compared to TAU.…”