Kahkoska Anna, Ercolino Gabriella, Ortega Jacob, Fruik Angela, Young Laura, Freeman Nikki
Department of Nutrition, University of North Carolina at Chapel Hill, 2205a McGavran Greenberg Hall, Chapel Hill, NC, 27599, USA.
Division of Endocrinology and Metabolism, School of Medicine, University of North Carolina at Chapel Hill Chapel Hill, Chapel Hill, NC, 27599, USA.
Curr Diab Rep. 2025 Jun 18;25(1):37. doi: 10.1007/s11892-025-01594-2.
Care guidelines recommend screening and intervention for diabetes distress (DD) as part of standard type 1 diabetes (T1D) care. The variability in how individuals with diabetes experience distress, alongside the range of treatment options, underscores the value of tailoring approaches for addressing diabetes distress. Our objective was to summarize contemporary clinical trials addressing DD directly in adults with T1D, focusing on evidence of heterogenous treatment effects.
We reviewed five studies testing diverse intervention strategies, including emotional support, telehealth, digital health platforms, and patient-centered communication. All studies were effective in reducing DD. Four studies examined the variation in treatment effects or outcomes in relation to observable participant characteristics and demonstrated heterogeneity both in the factors associated with changes in DD and factors associated with the differential impact of specific interventions. This review uncovered preliminary evidence of heterogeneous treatment effects across a range of DD-focused interventions. Gaining a deeper, more comprehensive understanding of the individuals or subgroups for whom evidence-based DD strategies are particularly effective versus less effective is needed to advance data-driven personalized treatment for DD. Future studies should prioritize diversity in enrolled individuals and advanced analytic approaches that can empirically match individuals with elevated DD to their optimal treatment approach.
护理指南建议将糖尿病困扰（DD）的筛查和干预作为1型糖尿病（T1D）标准护理的一部分。糖尿病患者体验困扰的方式存在差异，再加上治疗选择的范围，凸显了针对糖尿病困扰量身定制方法的价值。我们的目的是总结直接针对成年T1D患者DD的当代临床试验，重点关注异质性治疗效果的证据。
我们回顾了五项测试不同干预策略的研究，包括情感支持、远程医疗、数字健康平台和以患者为中心的沟通。所有研究在减轻DD方面均有效。四项研究考察了与可观察到的参与者特征相关的治疗效果或结果的差异，并证明在与DD变化相关的因素以及与特定干预措施的不同影响相关的因素方面均存在异质性。本综述揭示了一系列以DD为重点的干预措施中异质性治疗效果的初步证据。为了推进基于数据的DD个性化治疗，需要更深入、更全面地了解哪些个体或亚组采用循证DD策略特别有效，哪些效果较差。未来的研究应优先考虑纳入个体的多样性以及先进的分析方法，这些方法可以根据经验将DD升高的个体与其最佳治疗方法相匹配。
