Improve Diabetes Education and Mentality to Decrease Diabetes Stress

Two new studies in patients with type 1 diabetes presented at the 83rd Scientific Sessions of the American Diabetes Association (ADA) show that interventions that explicitly address diabetes misery can not only enhance patient mental health but can also reduce costs.

During an oral session, Danielle Hessler Jones, PhD, discussed the results of the study Behavioral Approaches to Reducing Diabetes Distress and Improving Glycemic Control (EMBARK) in individuals with type 1 diabetes.

The three-arm randomized study discovered that patients' emotions of helplessness significantly diminished following a three-month behavioral intervention that combines type 1 diabetes education and concentrated attention on diabetic misery.

Additionally, David V. Wagner, PhD, demonstrated in a late-breaking poster titled "Do The Right Thing: Behavioral Intervention for At-Risk T1D Youth," that a behavioral intervention not only enhanced glycemic control but also decreased the cost of care for underprivileged youth.

Diabetes distress, according to Hessler Jones, professor and vice chair for research in the Department of Family and Community Medicine at the University of California, San Francisco, is the emotional reaction to having diabetes, the stress of relentless daily self-management, and the possibility of its long-term complications.

It is more prevalent than depression, affecting 20% to 58% of persons with type 1 and type 2 diabetes, and it differs from depression in that it is linked to managing glycemic control and the condition. She emphasized that it "is also chronic and does not go away on its own without intervention."

"It is the expected worries, concerns, and fears that are associated with struggling with a demanding and progressive chronic disease and its management," she continued.

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The results of EMBARK "suggest that interventions that integrate education alongside methods to address the emotional side of diabetes are most effective at reducing distress," she said.

Results from the group's analysis of the three separate EMBARK treatments' effects on A1c are anticipated this fall.

Hessler Jones said that DDASSIST, which will provide a solution to the query, "How do I translate this into care in my clinic?" has also recently secured financing. The clinic training program's objective is to train the diabetes care team in the intervention.

A participant in the audience questioned whether someone other than a psychologist could deliver the session. She said, "They'll be looking at this."

For young people with type 1 diabetes who attended Novel Interventions in Children's Healthcare (NICH), an intensive behavioral health intervention, researchers Wagner and colleagues evaluated direct healthcare spending data from three healthcare systems.

The studies included young people with type 1 diabetes who had at least a year's worth of cost data both before and after joining the NICH. Costs for emergency departments, outpatient care, and inpatient care were all bundled. 53 teenagers with the following characteristics were examined. The population is varied, averaging 14.2 years old, 87% Medicaid, 58% female, 32% Black, 29% Non-Hispanic White, 28% Hispanic/Latinx, 7% Pacific Islander, 2% Asian, and 2% from other racial and ethnic groupings.

These findings demonstrate the advantages of giving pediatric populations dealing with health disparities access to intensive interventions, according to Wagner. "Investing early in the lives of youth who are experiencing health disparities is not only the right thing to do to improve patients' health but it could also have a positive economic impact down the road."

Interventions in 300 Adults with Type 1 Diabetes

Meanwhile, the EMBARK trial included 300 Americans with type 1 diabetes who were 21 years of age or older, had a high type 1 diabetes distress score (> 2.0), and had an A1c of less than 7.5%.

Participants were 79% female, on average 46 years old, and 89% White. They used an insulin pump and a continuous glucose monitor; their type 1 diabetes distress score (T1DDS) was 2.8; and their mean A1c was 8.3%.

Participants received one of three interventions at random:

Streamline: A typical management and teaching program run by a diabetic educator.

Tuned-in: A psychologist-led program that only seeks to reduce anxiety associated with diabetes.

All three therapies resulted in statistically significant and significant decreases in overall diabetic distress, with the combined intervention group seeing the largest decreases (P =.005) compared to the educational approach alone group.

At the follow-up, 25% of individuals in Streamline, 37% of participants in Tuned-in, and 42% of participants in Fixit no longer reported having elevated diabetes distress.

The Fixit intervention group had a higher percentage of participants reporting a minimal clinically important difference (the smallest change in a treatment outcome that an individual would deem important) than the Tuned-in (74%) or Streamline (65%) interventions.

"Where the Real Magic Happens Is When You Add the Psychologist"

"The certified diabetes care specialist (CDCS) intervention is really a very standard thing that most clinicians would have access to; they tend to focus on knowledge and problem-solving as well as some of the psychosocial issues," Robert Gabbay, MD, PhD, chief scientific and medical officer for the ADA, told Medscape Medical News.

A "graded response: CDCS alone, psychologist really focused on diabetes distress, and the two together, which would be the ideal practice model," he said of the results of the EMBARK research.

It is possible to measure diabetes distress using these proven methods utilizing a diabetes distress survey questionnaire, which is also underutilized.

"Adding the psychologist is really where the real magic happens in terms of diabetes distress," Gabbay claimed.

He said it would be challenging and unlikely to be very helpful for someone who feels helpless to control their diabetes.

ADA 2023 Scientific Sessions. Presented on June 24, 2023.