Researchers have long known that diabetes distress — worrying excessively about your diabetes or blood glucose control, or feeling powerless in the face of diabetes — is linked to worse blood glucose control and other diabetes-related outcomes. But the relationship between these outcomes and distress hasn’t always been exactly clear, since it could run in two directions — it’s not hard to imagine how distress could lead to worse outcomes, or how worse diabetes control could lead to distress. So the design of the new study is noteworthy, since it didn’t simply compare outcomes in people with different levels of diabetes distress. Instead, it measured the effects of a targeted program aimed at reducing diabetes distress.
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The study’s participants were 301 adults with type 1 diabetes, with an average age of 45 and and average A1C level (a measure of long-term blood glucose control) of 8.8%, indicating less than ideal glucose control. Participants were randomly assigned to one of two groups, with the aim of seeing what kinds of interventions helped reduce diabetes distress. The first group took a direct approach toward reducing diabetes distress, hearing and discussing ways to reduce the psychological burden of diabetes. The second group took an education-based approach, to see if learning more about diabetes and its management had an impact on diabetes distress. Participants received assessments at the beginning of the study as well as nine months later, looking at self-reported diabetes distress and self-care, A1C, and how frequently they experienced hypoglycemia (low blood glucose).
Reduction in diabetes distress linked to better blood glucose control
The researchers found that regardless of which group participants were assigned to, a reduction in diabetes distress was linked to better diabetes-related self-care and blood glucose control. People who experienced a reduction in diabetes distress missed fewer insulin doses, adjusted their insulin doses more frequently, tested their blood glucose more frequently, and were more likely to adopt continuous glucose monitoring (CGM). They also experienced fewer episodes of hypoglycemia and tended to see a lower A1C level over time.
Ad noted in a Medical Dialogues article on the study, participants who were assigned to the group that directly tackled diabetes distress were more likely than those in the education-oriented group to experience a reduction in diabetes distress. But both approaches had some success, so it’s possible than an intervention based on both psychological and educational approaches could be most effective at reducing diabetes distress.
The results indicate that reductions in diabetes distress do not affect blood glucose outcomes directly, but instead “through improvements in self-care behavior,” the researchers wrote. These findings “support the importance of integrating disease management with [diabetes distress] interventions to maximize improvements” in blood glucose control.
Want to learn more about managing diabetes distress? Read “Diabetes Distress: Another ‘Complication’ of Having Diabetes.”