A time-limited, problem-orientated psychotherapeutic intervention in Type 1 diabetic patients with complications: a randomized controlled trial

Diabet Med. 2002 Oct;19(10):814-21. doi: 10.1046/j.1464-5491.2002.00811.x.

Abstract

Aims: To examine the effects of a time-limited, problem-orientated psychotherapeutic intervention on self-defined psychological problems and metabolic control in Type 1 diabetic patients with microvascular complications.

Design: Randomized wait-list controlled trial with a follow-up of 6 months.

Setting: Out-patient clinic of a university diabetes centre.

Participants: Forty-six Type 1 diabetic patients with intensified insulin therapy and presence of microvascular diabetic complications. Twenty-four patients were randomly allocated to the intervention group and 22 patients to the control group.

Intervention: Participation in a structured, problem-orientated, time-limited psychotherapeutic intervention (IG). The control group (CG) patients received routine diabetes care in a specialized diabetes university clinic.

Outcome measures: Degree of change of three self-defined main psychological and psychosocial problems (no. 1, no. 2 and no. 3) on a 1-10 graded scale and glycosylated haemoglobin HbA1c values.

Results: Two patients (one in each group) died during the study period. All remaining patients were followed for 6 months. Problem scores were high at baseline in both groups: IG/CG (mean values, standard deviation in parentheses): problem no. 1, 7.8 (2.0)/8.3 (1.7); problem no. 2, 7.7 (2.3)/7.6 (1.8); and problem no. 3, 7.7 (2.3)/7.4 (2.6). At follow-up, all problems were significantly lower in the intervention group (IG) when compared with the CG: IG/CG: problem no. 1, 4.3 (2.9)/6.8 (3.0), P = 0.03; problem no. 2, 3.9 (2.4)/5.8 (2.8), P = 0.03; problem no. 3, 4.7 (2.4)/6.8 (2.4), P = 0.02. Mean HbA1c decreased in the intervention group by 0.6 (1.2)% and increased in the control group by 0.1 (0.7)%, P = 0.016. In patients with suboptimal metabolic control, i.e. HbA1c > 8%, mean HbA1c decreased by 1.0 (1.2)% in the IG and increased by 0.1 (0.7)% in the CG, P = 0.011.

Conclusion: A time-limited, structured, problem-orientated psychotherapeutic intervention decreases the severity of psychological problems and improves metabolic control in Type 1 diabetic patients with microvascular complications and self-management of intensified insulin therapy.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Analysis of Variance
  • Blood Glucose Self-Monitoring
  • Diabetes Mellitus, Type 1 / blood
  • Diabetes Mellitus, Type 1 / psychology
  • Diabetes Mellitus, Type 1 / therapy*
  • Diabetic Nephropathies / blood
  • Diabetic Nephropathies / psychology
  • Diabetic Nephropathies / therapy
  • Diabetic Neuropathies / blood
  • Diabetic Neuropathies / psychology
  • Diabetic Neuropathies / therapy
  • Diabetic Retinopathy / blood
  • Diabetic Retinopathy / psychology
  • Diabetic Retinopathy / therapy
  • Female
  • Follow-Up Studies
  • Glycated Hemoglobin A / analysis
  • Humans
  • Insulin / administration & dosage
  • Male
  • Patient Compliance*
  • Problem Solving
  • Psychotherapy / methods*
  • Self Administration
  • Statistics, Nonparametric
  • Time Factors

Substances

  • Glycated Hemoglobin A
  • Insulin