Group-based behaviour therapy improves self-care, glycaemic control and distress in adults with type 1 diabetes

Melanie S Burkhardt; Carlo Pirri; Mark A Summers; Pixie Barrie; Mahnaz Aghabozorgi; P Gerry Fegan; Bu B Yeap

doi:10.1016/j.diabres.2024.111095

Group-based behaviour therapy improves self-care, glycaemic control and distress in adults with type 1 diabetes

Diabetes Res Clin Pract. 2024 Feb:208:111095. doi: 10.1016/j.diabres.2024.111095. Epub 2024 Jan 17.

Authors

Melanie S Burkhardt¹, Carlo Pirri², Mark A Summers³, Pixie Barrie⁴, Mahnaz Aghabozorgi⁵, P Gerry Fegan⁶, Bu B Yeap⁷

Affiliations

¹ Medical School, University of Western Australia, Perth, Western Australia, Australia; Department of Endocrinology and Diabetes, Fiona Stanley Fremantle Hospitals Group, Perth, Western Australia, Australia; Department of Clinical Psychology and Clinical Neuropsychology, Fiona Stanley Fremantle Hospitals Group, Perth, Western Australia, Australia. Electronic address: melanie.burkhardt@health.wa.gov.au.
² Department of Endocrinology and Diabetes, Fiona Stanley Fremantle Hospitals Group, Perth, Western Australia, Australia; MedEd Australis, Fremantle, Western Australia, Australia.
³ Centre for Clinical Interventions, Northbridge, Western Australia, Australia.
⁴ Department of Endocrinology and Diabetes, Fiona Stanley Fremantle Hospitals Group, Perth, Western Australia, Australia.
⁵ Department of Endocrinology and Diabetes, Fiona Stanley Fremantle Hospitals Group, Perth, Western Australia, Australia; Department of Dietetics, Fiona Stanley Fremantle Hospitals Group, Perth, Western Australia, Australia.
⁶ Department of Endocrinology and Diabetes, Fiona Stanley Fremantle Hospitals Group, Perth, Western Australia, Australia; Medical School, Curtin University, Perth, Western Australia, Australia.
⁷ Medical School, University of Western Australia, Perth, Western Australia, Australia; Department of Endocrinology and Diabetes, Fiona Stanley Fremantle Hospitals Group, Perth, Western Australia, Australia.

PMID: 38242292
DOI: 10.1016/j.diabres.2024.111095

Abstract

Aims: Psychological interventions have had modest effects on HbA1c in adults with Type 1 diabetes (T1D). We evaluated a novel behaviour therapy (BT) group program aiming to improve diabetes self-care and reduce HbA1c and distress. Core features were the application of a functional-analytic model, behavioural self-management training, and personally selected T1D self-care behaviours as treatment targets.

Methods: Participants with T1D, 2-consecutive HbA1c ≥ 8.5 %(69 mmol/mol) and/or diabetes-related emotional/behavioural difficulties who had received specialist multidisciplinary input for ≥2 years completed 6-sessions of BT over 9-weeks. Outcomes were assessed at baseline, on completing 5-consecutive weekly sessions (post-) and at session 6, 1-month after (follow-up).

Results: Of 66 participants mean age 37.9 years, mean age at T1D diagnosis 22.0 years, and median T1D duration 14 years, 54 completed BT. HbA1c improved from baseline to follow-up (9.7 ± 1.9 %-8.8 ± 1.3 %, p < 0.001), as did diabetes distress (DD: total score 49.2 ± 7.8 baseline, 38.9 ± 14.7 post- and 32.8 ± 11.7 follow-up, p < 0.001). All DD subscales of emotional burden, and physician, regimen, and interpersonal distress, improved (p < 0.001). Consistent results were observed for patients on multiple daily injections and continuous subcutaneous insulin infusion therapy.

Conclusions: BT based on a functional-analytic and behavioural self-management model holds promise as an effective means of improving HbA1c and reducing DD in adults with T1D.

Keywords: Behaviour therapy; Diabetes distress; Diabetes self-care behaviour; Glycaemic control; HbA(1c); Type 1 diabetes.

MeSH terms

Adult
Behavior Therapy
Diabetes Mellitus, Type 1* / psychology
Diabetes Mellitus, Type 1* / therapy
Glycated Hemoglobin
Glycemic Control
Humans
Infant
Self Care / psychology

Substances

Glycated Hemoglobin