Therapy by Telehealth Improves Blood Glucose Control, Diabetes Distress

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Therapy by Telehealth Improves Blood Glucose Control, Diabetes Distress

Seeing a therapist by telehealth may help people with type 2 diabetes improve their blood glucose control and reduce diabetes-related distress, according to a new study published in the journal The Science of Diabetes Self-Management and Care.

Diabetes-related distress is an often overlooked aspect of living with diabetes, and has a harmful effect on quality of life — and on blood glucose control — in many people with both type 1 and type 2 diabetes. Research has shown that a number of factors can contribute to diabetes distress, including social factors like food insecurity and lifestyle factors like poor sleep quality. Several studies have shown that higher levels of diabetes distress are linked to worse blood glucose control in people with type 1 diabetes, and the evidence shows that diabetes distress can be treated and reduced — usually with better blood glucose control as a result.

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For the latest study, the researchers looked at a therapist-guided practice called cognitive behavioral therapy (CBT). This scientifically validated form of psychotherapy involves identifying distorted, unhelpful, or destructive thinking patterns and trying to replace them with a pragmatic, problem-solving way of thinking and acting. While CBT has been shown to be effective in many different contexts, there weren’t any known previous studies on whether the practice could help reduce diabetes distress when it’s done through telehealth rather than in-person appointments. (Telehealth, also known as telemedicine, involves seeing a health care provider remotely through a video or audio link.)

The study participants were 12 people with type 2 diabetes who took at least one glucose-lowering medication (potentially including insulin) and had an A1C level (a measure of long-term blood glucose control) of 8% or higher, indicating less-than-optimal blood glucose control. The participants were randomly assigned to one of four different groups, with three people in each group. The first group simply received their usual care. The second, third, and fourth groups took part in six, eight, or 12 weekly sessions of cognitive-behavioral therapy over the phone — which were specifically geared toward reducing diabetes distress and improving self-management behaviors — and also had access to a smartphone app to practice their CBT skills.

Improvements seen from telehealth CBT

After 16 weeks, members of all three CBT groups reported lower levels of diabetes distress and had lower A1C levels — but so did members of the usual-care group. The greatest improvements in A1C — an average drop of 2.33% — and in diabetes distress were seen in the 12-week CBT group. In comparison, the usual-care group saw an average A1C reduction of 2.15% and a small improvement in diabetes distress. It’s unknown why, exactly, the usual-care group saw such a dramatic improvement in A1C along with the three CBT groups — but it’s possible that simply knowing their blood glucose control was being assessed as part of a study led some participants to improve their self-management behaviors.

“This study demonstrates that telehealth CBT augmented with a smartphone application is feasible and acceptable,” the researchers concluded, while noting that larger studies are needed to demonstrate a beneficial effect from telehealth therapy sessions.

Want to learn more about telehealth? read “Diabetes and Telehealth: Tips for a Successful Virtual Visit.”

Living with type 2 diabetes? Check out our free type 2 e-course!

Originally Published January 18, 2023
Quinn Phillips

Quinn Phillips

Quinn Phillips on social media

A freelance health writer and editor based in Wisconsin, Phillips has a degree from Harvard University. He is a former Editorial Assistant for Diabetes Self-Management and has years of experience covering diabetes and related health conditions. Phillips writes on a variety of topics, but is especially interested in the intersection of health and public policy.

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