Psychiatry, University College Dublin, Dublin, Ireland
Psychiatry, Mater Misericordiae University Hospital, Dublin, Ireland.
BMJ Open Diabetes Res Care. 2021 Jan;9(1). doi: 10.1136/bmjdrc-2020-001934.
This study examines the feasibility of conducting diabetes-focused cognitive-behavioral therapy (CBT) via a secure online real-time instant messaging system intervention to support self-management and improve glycemic control in people with type 1 diabetes.
We used a pre-post uncontrolled intervention design over 12 months. We recruited adults with type 1 diabetes and suboptimal glycemic control (HbA1c ≥69 mmol/mol (DCCT 8.5%) for 12 months) across four hospitals in London. The intervention comprised 10 sessions of diabetes-focused CBT delivered by diabetes specialist nurses. The primary outcomes were number of eligible patients, rates of recruitment and follow-up, number of sessions completed and SD of the main outcome measure, change in HbA1c over 12 months. We measured the feasibility of collecting secondary outcomes, that is, depression measured using Patient Health Questionnaire-9 (PHQ-9), anxiety measured Generalised Anxiety Disorder (GAD) and the Diabetes Distress Scale (DDS).
We screened 3177 patients, of whom 638 were potentially eligible, from whom 71 (11.1%) were recruited. The mean age was 28.1 (13.1) years, and the mean HbA1c was 84.6 mmol/mol (17.8), DCCT 9.9%. Forty-six (65%) patients had at least 1 session and 29 (41%) completed all sessions. There was a significant reduction in HbA1c over 12 months (mean difference -6.2 (2.3) mmol/mol, DCCT 0.6%, p=0.038). The change scores in PHQ-9, GAD and DDS also improved.
It would be feasible to conduct a full-scale text-based synchronized real-time diabetes-focused CBT as an efficacy randomized controlled trial.
本研究旨在通过安全的在线实时即时通讯系统干预，检验针对糖尿病的认知行为疗法（CBT）的可行性，以支持自我管理并改善 1 型糖尿病患者的血糖控制。
我们采用了 12 个月的预前后对照非随机干预设计。我们招募了来自伦敦 4 家医院的 1 型糖尿病患者和血糖控制不佳（HbA1c≥69mmol/mol（DCCT 8.5%）达 12 个月）的成年人。干预措施包括由糖尿病专科护士提供的 10 次针对糖尿病的 CBT 课程。主要结局指标是合格患者的数量、招募和随访率、完成的课程数量以及主要结局测量值的标准差（HbA1c 在 12 个月内的变化）。我们测量了次要结局（使用患者健康问卷-9（PHQ-9）测量的抑郁、广泛性焦虑障碍（GAD）和糖尿病困扰量表（DDS）测量的焦虑）的收集可行性。
我们共筛查了 3177 名患者，其中 638 名可能符合条件，其中 71 名（11.1%）被招募。患者的平均年龄为 28.1（13.1）岁，平均 HbA1c 为 84.6mmol/mol（17.8），DCCT 9.9%。46（65%）名患者至少参加了 1 次课程，29（41%）名患者完成了所有课程。HbA1c 在 12 个月内显著降低（平均差值-6.2（2.3）mmol/mol，DCCT 0.6%，p=0.038）。PHQ-9、GAD 和 DDS 的评分也有所改善。
开展基于文本的同步实时糖尿病 CBT 全规模试验是可行的。
