Do Virtual Behavior Interventions Lower T1D Distress?

TOPLINE:

In adults with type 1 diabetes (T1D), both management- and emotion-focused virtual group programs can lead to a clinically meaningful reduction in diabetes distress (DD) and A1c levels.

METHODOLOGY:

• Increased DD among adults with T1D leads to poor self-management and suboptimal glycemic outcomes; virtual interventions focused on emotions and/or education could reduce DD and A1c levels in adults with T1D.
• The EMBARK trial compared three virtual interventions in 276 individuals with T1D (mean age, 46.8 years; 79.6% women) who had an elevated DD score of ≥ 2 on the T1D distress scale and an A1c ≥ 7.5%.
• Researchers randomly assigned participants to one of the three group-based virtual interventions:
  • Streamline: An evidence-based program to provide educational review to resolve glycemic challenges (intervention time, ≤ 4.5 hours), delivered for 3 months.
  • TunedIn: An emotion-focused approach to review and provide structured guidance to reduce distress due to T1D (intervention time, ≤ 10.5 hours), delivered for 3 months.
  • FixIt: A combination of Streamline and TunedIn (intervention time, ≤ 16 hours), delivered for 4 months.
• At baseline and at 3-, 6-, and 12-month follow-ups, they measured DD and obtained A1c levels from either the clinical records or from a laboratory test.
• They also evaluated the proportion of individuals whose DD score reduced

TAKEAWAY:

• Over 12 months, DD and A1c levels decreased significantly from baseline with all three interventions.
• Participants in TunedIn or FixIt experienced a greater decrease in DD (Cohen’s d of 1.14 and 1.06, respectively) than those in Streamline (Cohen’s d of 0.58).
• A1c levels remained low in all three groups at 6 months, but at 12 months, Streamline (difference from baseline [D], −0.65; P P
• An increased percentage of participants in TunedIn (50.2%) achieved the DD threshold of 2.0 compared with Streamline (27.2%) and FixIt (30.7%).

IN PRACTICE:

“Our results suggest that both management- and emotion-focused group programs for adults with T1D can lead to significant and clinically meaningful reductions in DD [diabetes distress] and HbA1c,” the authors wrote.

SOURCE:

The study was led by Danielle M. Hessler, PhD, University of California, San Francisco, and was published online in Diabetes Care.

LIMITATIONS:

Data were collected during the COVID-19 pandemic; therefore, the high stress levels of participants might have affected outcomes. The virtual interventions had different durations. The results might not be generalizable because the study included people with internet access, and most participants were non-Hispanic White women.

DISCLOSURES:

The study was supported by the National Institute of Diabetes and Digestive and Kidney Diseases. Some authors reported being consultants, serving on advisory boards, or receiving speaker fees from pharmaceutical and medical device companies.