A new study of adults led by researchers at the University of California, San Francisco, finds that the most effective way to reduce the pain associated with diabetes and improve blood sugar control is to help people feel the emotional impact of living with diabetes. It turns out that the focus is on managing tensions.
Diabetic distress (DD) refers to the fear, worry, and burden associated with living with and managing diabetes, which affects up to 75% of adults with type 1 diabetes. This is associated with poor self-management, including forgetting to take medications, increased blood sugar levels, increased hypoglycemia (hypoglycemia), and decreased quality of life.
Most people with diabetes have never heard of the pain of diabetes, never been asked about it, and don't understand that it can be alleviated. ”
recent studywas published in diabetes carewe compared three group programs that were all delivered virtually. The first focused on diabetes education and management, the second focused on the emotional aspects of living with diabetes, and the third combined the two approaches.
All three programs produced significant and clinically meaningful reductions in hemoglobin A1C, which measures diabetic distress and glycemic control. However, an emotion-focused program called TunedIn showed the most consistent effects and was far more effective at lowering DD than any other intervention studied to date.
“Most people with diabetes have never heard of the pain of diabetes, never been asked about it, and don't understand that it can be alleviated,” said the first author. Daniel Hessler JonesPh.D., professor and associate director of research in the UCSF School of Family and Community Medicine. “Knowing that virtual group-based programs are effective is an opportunity to change that.”
Improving access to care
The study, conducted from 2019 to 2022, involved 276 adults with type 1 diabetes and high diabetes distress. Participants will be randomly assigned to one of three programs, each of which will include a series of virtual meetings over three to four months, including group workshops, group calls, and one-on-one calls with instructors. was included.
Half of the study participants felt no longer suffering from diabetes after using TunedIn for one year, compared to 27% of those who used the education-based program and 31% of those who used the combination program. did. TunedIn also had the highest percentage of participants (56%) with a 0.5% or more reduction in A1C, which is clinically and statistically significant.
If you don't address the emotional part of living with an illness, it won't work. ”
TunedIn incorporates elements and strategies from Acceptance and Commitment Therapy (ACT) to promote awareness of how painful emotions and beliefs can lead to behaviors that are at odds with diabetes management. Masu. Previous research has proven that ACT strategies are effective for a variety of chronic diseases and other stress-related conditions.
“By providing people with type 1 diabetes with the opportunity to recognize and observe these processes and to 'stand alongside them', they can make different choices that have the potential to positively impact their health and well-being.” “There may be a choice to be made,” Jones said.
Based on this research, UCSF Diabetes Center has begun to incorporate diabetes distress screening into its practices.
“If you don't address the emotional part of living with an illness, it won't work,” says the co-author. Umesh MasharaniMBBS, Professor of Endocrinology at UCSF. “It is important that clinicians are trained in how to have these conversations with patients with diabetes as part of their routine care.”
TunedIn has the potential to expand access to patients across the country, and potentially around the world, for patients in diabetic distress who are unable to schedule treatment with a clinical specialist, Jones added. The research team's work gained international attention through the leadership of co-author Lawrence Fisher, Ph.D., ABPP, professor emeritus at UCSF and director of the Behavioral Diabetes Research Group. Mr Fisher is currently working with colleagues to implement DD programs in the UK and Europe.
“With so few mental health professionals and psychologists trained in diabetes, virtual programs are the best way to provide this type of evidence-based treatment to patients who cannot come to see us. We really need it,” Jones said.
author: Additional co-authors from UCSF are Sarah Kim, MD, and Katherine Greenberg.
Funding: This study was funded by the National Institute of Diabetes and Digestive and Kidney Diseases (R01DK121241).