University of California, San Francisco, San Francisco, CA
University of California, San Francisco, San Francisco, CA.
Diabetes Care. 2018 Sep;41(9):1862-1869. doi: 10.2337/dc18-0391. Epub 2018 Jul 5.
To compare the effectiveness of two interventions to reduce diabetes distress (DD) and improve glycemic control among adults with type 1 diabetes (T1D).
Individuals with T1D ( = 301) with elevated DD and HbA were recruited from multiple settings and randomly assigned to OnTrack, an emotion-focused intervention, or to KnowIt, an educational/behavioral intervention. Each group attended a full-day workshop plus four online meetings over 3 months. Assessments occurred at baseline and 3 and 9 months. Primary and secondary outcomes were change in DD and change in HbA, respectively.
With 12% attrition, both groups demonstrated dramatic reductions in DD (effect size = 1.06; 78.4% demonstrated a reduction of at least one minimal clinically important difference). There were, however, no significant differences in DD reduction between OnTrack and KnowIt. Moderator analyses indicated that OnTrack provided greater DD reduction to those with initially poorer cognitive or emotion regulation skills, higher baseline DD, or greater initial diabetes knowledge than those in KnowIt. Significant but modest reductions in HbA occurred with no between-group differences. Change in DD was modestly associated with change in HbA ( = 0.14, = 0.01), with no significant between-group differences.
DD can be successfully reduced among distressed individuals with T1D with elevated HbA using both education/behavioral and emotion-focused approaches. Reductions in DD are only modestly associated with reductions in HbA. These findings point to the importance of tailoring interventions to address affective, knowledge, and cognitive skills when intervening to reduce DD and improve glycemic control.
比较两种干预措施在降低 1 型糖尿病（T1D）成人糖尿病困扰（DD）和改善血糖控制方面的效果。
从多个地点招募了患有 T1D（n=301）且 DD 升高和 HbA 升高的个体，并将其随机分配到以情绪为焦点的干预组 OnTrack 或以教育/行为为重点的干预组 KnowIt。两组均参加了为期一天的研讨会和三个月内的四次在线会议。在基线、3 个月和 9 个月时进行评估。主要和次要结局分别为 DD 的变化和 HbA 的变化。
在 12%的脱落率下，两组的 DD 均显著降低（效应量 = 1.06；78.4%的人至少减少了一个最小临床重要差异）。然而，OnTrack 和 KnowIt 之间的 DD 降低没有显著差异。调节分析表明，对于初始认知或情绪调节技能较差、基线 DD 较高或初始糖尿病知识较高的患者，OnTrack 提供了更大的 DD 降低。HbA 有显著但适度的降低，两组之间没有差异。DD 的变化与 HbA 的变化适度相关（ = 0.14， = 0.01），两组之间没有显著差异。
使用教育/行为和以情绪为焦点的方法，可以成功降低 HbA 升高的 T1D 困扰个体的 DD。DD 的降低与 HbA 的降低仅适度相关。这些发现表明，在干预降低 DD 和改善血糖控制时，针对情感、知识和认知技能进行干预的重要性。
