Diabetes distress, emotional regulation, HbA1c in people with diabetes and A controlled pilot study of an emotion-focused behavioral therapy intervention in adults with type 2 diabetes

Emil F Coccaro; Tina Drossos; David Kline; Sophie Lazarus; Joshua J Joseph; Mary de Groot

doi:10.1016/j.pcd.2022.03.002

Diabetes distress, emotional regulation, HbA_1c in people with diabetes and A controlled pilot study of an emotion-focused behavioral therapy intervention in adults with type 2 diabetes

Prim Care Diabetes. 2022 Jun;16(3):381-386. doi: 10.1016/j.pcd.2022.03.002. Epub 2022 Mar 11.

Authors

Emil F Coccaro¹, Tina Drossos², David Kline³, Sophie Lazarus⁴, Joshua J Joseph⁵, Mary de Groot⁶

Affiliations

¹ Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, Columbus, OH, USA. Electronic address: emil.coccaro@osumc.edu.
² Department of Psychiatry and Behavioral Neuroscience, Pritzker School of Medicine, The University of Chicago, IL, USA.
³ Department of Biomedical Informatics, Center for Biostatistics, The Ohio State University Wexner Regulation Medical Center, Columbus, OH, USA.
⁴ Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
⁵ Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
⁶ Department of Medic ine, Indiana University School of Medicine, Indianapolis, IN, USA.

Abstract

Aim: One potential barrier for people with diabetes to reach glycemic goals is diabetes distress. Accumulating evidence suggests diabetes distress may be linked to individuals' emotion regulation capacities. Thus, we conducted two studies to elucidate a model for how emotion regulation impacts diabetes distress and A_1c levels and determine preliminary effect size estimates for an intervention targeting poor emotion regulation on glycemic control.

Methods: Study I used structural equation modeling to assess the cross-sectional relationships between these variables in a sample of 216 individuals with Type 1 and Type 2 diabetes. Study II built on findings from Study I that highlighted the role of emotion regulation capacities in diabetes distress and A_1c by conducting a pilot study of an emotion-focused behavioral intervention compared to treatment as usual in a sample of individuals with Type 2 diabetes.

Results: Study I examined two potential explanatory models with one of the models (Model II) showing a more comprehensive view of the data revealing a total effect of poor emotional regulation of 42% of all effects on A_1c levels. Study II tested an emotion-focused behavioral intervention in patients with Type 2 diabetes compared to treatment as usual and found medium sized reductions in A_1c levels and smaller reductions in diabetes distress that correlated with changes in emotion regulation.

Conclusions: These studies suggest that, in people with diabetes, elevated A_1c levels and diabetes distress are linked with poor emotion regulation. While the effect sizes from Study 2 are preliminary, an emotion-focused behavioral intervention may reduce both A_1c and diabetes distress levels, through improvements in emotion regulation. Overall, these data suggest that targeting difficulties in emotion regulation may hold promise for maximizing improvement in diabetes distress and A_1c in individuals with diabetes.

Keywords: Diabetes Distress; Diabetes Self-Management; Emotional Regulation; Hemoglobin A1c.

Publication types

Randomized Controlled Trial
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Behavior Therapy
Diabetes Mellitus, Type 2* / diagnosis
Diabetes Mellitus, Type 2* / psychology
Diabetes Mellitus, Type 2* / therapy
Emotional Regulation*
Emotions
Glycated Hemoglobin / analysis
Humans
Pilot Projects

Substances

Glycated Hemoglobin A

Grants and funding

P30 DK092949/DK/NIDDK NIH HHS/United States