Psychological Therapy to Improve Control of Type 1 Diabetes. Ann Intern Med. 2008;149:I-48. doi: 10.7326/0003-4819-149-10-200811180-00001
Download citation file:
Published: Ann Intern Med. 2008;149(10):I-48.
Type 1 diabetes mellitus (also called childhood diabetes) occurs when the pancreas stops making insulin. Insulin helps the body use the energy that foods provide. Without insulin, blood sugar levels become high. Over time, high blood sugar levels can lead to blindness, kidney failure, damage to nerves, and heart disease. To keep blood sugar levels in the normal range, people with type 1 diabetes must inject insulin and monitor their diet and exercise. Psychological issues can interfere with a patient's ability and confidence to manage their diabetes, and it is possible that psychological treatments could improve diabetes control.
To find out whether psychological therapy can improve blood sugar control for patients with type 1 diabetes. They were interested in 2 types of therapy: motivational enhancement therapy and cognitive behavior therapy. Motivational enhancement therapy is brief therapy (1 to 4 sessions) during which the therapist counsels the patient to motivate him or her to follow healthy behaviors. Cognitive behavior therapy is longer therapy (6 to 12 sessions) that tries to help patients identify unhelpful behaviors and replace them with more helpful ones. They were also interested to find out if diabetes nurses could be trained to deliver these psychological treatments because it is not always possible to access a psychologist.
344 adults with type 1 diabetes at 8 diabetes centers in the United Kingdom. To be in the study, patients had to have had diabetes for at last 2 years, a hemoglobin A1c (HbA1c) level of 8.2% to 15%, and no complications of diabetes or other severe medical conditions. Hemoglobin A1c is a blood test that measures sugar control over the past 3 months. In most cases, doctors and patients should aim for an HbA1c level less than 7%.
The researchers assigned patients to receive either motivational enhancement therapy, motivational enhancement therapy plus cognitive behavior therapy, or usual care. Trained nurses provided the psychological therapies. Patients who received motivational enhancement therapy had 4 sessions over 2 months. Patients who received cognitive behavior therapy had 12 sessions over 6 months. The researchers then collected information on change in HbA1c levels over 12 months, low blood sugar episodes, depression, quality of life, diabetes self-care activities, and weight.
Patients who received both psychological therapies had a greater decrease in HbA1c levels than patients who received usual care. Patients who received only motivational enhancement therapy did not have better blood sugar control than patients who received usual care. None of the other outcomes differed among the 3 groups.
No patient received only cognitive behavior therapy, so this study was unable to determine the effect of cognitive behavior therapy alone. Also, about 11% of the patients did not return for HbA1c measurements at 12-month follow-up. In addition, patients had HbA1c levels of 8.6% to 10.3% at the start of the study and no diabetes complications. It is possible that psychological therapies could have more benefit in patients who had worse diabetes control.
Combined psychological therapies (motivational enhancement therapy plus cognitive behavior therapy) resulted in clinically relevant improvements in blood sugar control in type 1 diabetes compared with usual care.
The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.
Cardiology, Endocrine and Metabolism, Diabetes, Coronary Risk Factors.
Results provided by:
Copyright © 2016 American College of Physicians. All Rights Reserved.
Print ISSN: 0003-4819 | Online ISSN: 1539-3704
Conditions of Use
This PDF is available to Subscribers Only