Randomized Trial of a Tailored Cognitive Behavioral Intervention in Type 2 Diabetes With Comorbid Depressive and/or Regimen-Related Distress Symptoms: 12-Month Outcomes From COMRADE

Abstract

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.

Benefits of Brief Group Cognitive Behavioral Therapy in Reducing Diabetes-Related Distress and HbA1c in Uncontrolled Type 2 Diabetes Mellitus Patients in Thailand

“…Eight of the twelve trials studies in that meta-analysis were involved in CBT and all eight reported improvement in long-term glycemic control and reduction of psychological distress in the CBT groups [32]. Similarly, several previous studies, e.g., Cummings et al [24], evaluated the effect of cognitive behavioral therapy (CBT) plus lifestyle counseling in primary care on HbA1c levels in rural adult patients with T2DM with comorbid depressive and/or medication adherence behavior-related distress symptoms. The Cummings study found that patients in the intervention group showed significant improvement in HbA1c levels and greater improvement in DRD compared to the group receiving standard care.…”

“…The present study found no significant differences in medication taking behavior or physical activity between the experimental group and control group, although medication taking behavior did improve in the experimental group. A study by Cummings et al [24] found that patients receiving CBT intervention evidenced significantly greater improvements in medication adherence than those receiving the usual care. There may be other factors, however, that affect medication taking behavior.…”

“…CBT has been applied in diabetic patients with depression—e.g., Safren et al [ 21 ] and Aguilera et al [ 22 ]—including diabetic patients with DRD. Amsberg et al [ 23 ] and Cummings et al [ 24 ] report experimental studies of diabetic patients who could not control their blood-sugar level and who also had DRD found significant improvement in HbA1c levels and reduction of diabetes-related distress among the CBT intervention group compared with the control group. Similarly, Seyed et al [ 25 ] conducted a quasi-experimental study of diabetic patients who could not control their blood-sugar levels and who had DRD.…”

Development of a Tailored Behavioral Weight Loss Program for Veterans With PTSD (MOVE!+UP): A Mixed-Methods Uncontrolled Iterative Pilot Study

“…to improve effectiveness for Veterans with PTSD is warranted. Despite evidence-based programs to address weight 25 -27 and related conditions like diabetes 28 among individuals with other mental health conditions, there are no such programs for individuals with PTSD. Importantly, VA supports efforts to tailor MOVE!…”

Insulin pricing and other major diabetes-related concerns in the USA: A study of 46,407 Tweets between 2017 and 2019

“…2 Reducing diabetes-related distress may improve HbA1c and reduce the burden of disease among people with diabetes. 3,4 However, current diabetes management guidelines dedicate little attention to the prevention and management of diabetes-related distress. This is due, in part, to the limited knowledge of the sources of stress, anxiety and concerns among people with diabetes and to the difficulty to capture 5,6 them with existing evaluation scales such as the Problem Areas in Diabetes Scale (PAID or PAID-T for adolescents) 7 or the Diabetes Distress Scale (DDS).…”