Emotional distress as a therapeutic target against persistent poor glycaemic control in subjects with type 1 diabetes: A systematic review.

Persistent poor glycaemic control is frequently observed in subjects with type 1 diabetes (T1D). The burden of diabetes self-management, fear of hypoglycaemia, and other diabetes-specific stressors are associated with diabetes distress and poor glycaemic control. However, psychological interventions to reduce diabetes distress have only benefited certain groups of patients. Psychosocial stressors (unemployment, financial problems) can lead to psychosocial distress and persistent poor glycaemic control in subjects with T1D. Therefore, diabetes distress and psychosocial distress can cause a similar state of 'emotional distress'. Here we conducted a systematic review of emotional distress and persistent poor glycaemic control in subjects with T1D. A total of 108 articles were identified in bibliographic databases (PubMed, Google Scholar, ScienceDirect, PsycNet APA, ERIC, EMBASE and Cochrane) and other literature sources. Of these, 24 articles were included in the analysis. As expected, diabetes stressors have been found to combine with psychosocial stressors to produce emotional distress and worsen glycaemic control. Psychological resilience and positive life events reduced the impact of emotional distress on glycaemic control. The EMBARK trial demonstrated the efficacy of an emotion-focused approach in achieving clinically significant long-term improvement in glycaemic control. In conclusion, emotional distress could be a new therapeutic target against persistent poor glycaemic control. This hypothesis could be tested in intervention trials including: (i) diabetes distress and psychosocial distress as main outcome measures, (ii) positive life events as a secondary outcome measure, and (iii) psychological resilience among the baseline characteristics of study participants.