Objective: To evaluate changes in behavioral and clinical outcomes from the DECIDE (Decision-making Education for Choices in Diabetes Everyday) self-management support program trial among participants with and without a mental health (MH) history.
Methods: Participants were urban African American adults with type 2 diabetes (T2DM) (N=182). DECIDE is a problem solving diabetes self-management support program. Participants were randomized to 1 of 4 intervention arms: Self Study (n=46), Individual (n=45), Group (n=46), or Enhanced Print Education (EPE; n=45). Those who screened positive on the Patient Health Questionnaire 2 or reported a mental health diagnosis were coded as having MH history. Outcomes were self-management, knowledge, problem solving, and A1C assessed at baseline and 6 months post intervention, stratified by MH history status.
Results: 72 participants (40%) reported a MH history, including depression, bipolar, and schizophrenia. Among those with no MH history, knowledge and problem solving improved at 6 months post intervention in all intervention arms (knowledge: Self Study p<.001, Individual p=.011, Group p=.004, EPE p=.026; problem solving: Self Study p=.023, Individual p=.015, Group p=.010, EPE p=.015). For those with MH history, knowledge and problem solving improved in the Self Study and Individual arms (diabetes knowledge: Self Study p=.018, Individual p=.037; health problem solving: Self Study p=.006, Individual p=.011) but not in the Group or EPE arms (ps≥.10). Although changes in A1C were not significant in any group (ps≥.20), A1C decreased by 1% among those with MH history in the Self Study arm (baseline A1C=9.1%; 6 month A1C=8.1%; p=.20).
Conclusion: In an urban minority sample with T2DM, those with a MH history benefited from a diabetes self-management intervention, but delivery modality mattered. Robust improvements in skills and A1C were observed when those with a MH history had self-paced or one-on-one formats rather than group.
E.A. Vrany: None. A. Jennings: None. F. Hill-Briggs: None.
National Heart, Lung, and Blood Institute (R01HL089751, 5T32HL007180)