The presence of distress symptoms in patients with uncontrolled type 2 diabetes (T2D) negatively influences diabetes management behaviors (DMB) and increases the risk of co-morbid complications. Cognitive behavioral interventions (CBI) are successful at reducing these symptoms, but the role of reducing Emotional Burden (EB) on diabetes behaviors is poorly understood. A prospective randomized trial involving 139 patients (mean age = 52.6 +/- 9.5 years; 27% black; 78% female; BMI = 37.0 +/- 9.0) with uncontrolled T2D (mean A1c = 9.6 +/-2) compared the effectiveness of a 16-week severity-tailored CBI plus lifestyle coaching (n=67; IG=intervention group) to usual care (n=72; CG=control group) on reducing EB and its impact on DMB such as self-care behaviors and medication adherence. Trained staff at a rural primary care clinic measured EB (subscore of Diabetes Distress Scale-17), self-care behaviors (Summary of Diabetes Self-Care Activities, SDSCA), and medication adherence (ModMAS) at baseline and 12-months follow-up using validated instruments. There were no differences between groups at baseline in mean age, race, or gender. The average reduction in EB, average improvement in ModMAS, and average improvement in self-care (SDSCA) were all significantly greater in the IG (-1.00 +/- 1.17; +1.0 ± 2.0; +1.1 ± 1.3) than in the CG (-.06 +/- 1.38; + 0.17 ± 1.9; +0.58 ± 1.4) (p=0.0001; p = 0.02; p = 0.027, respectively). Mean improvement in ModMAS was significantly and progressively related to improvements in EB in the IG (worse/same EB = -0.25 ±0.96; moderately improved EB = +0.79 ± 1.9; markedly improved EB = +1.6 ± 2.2; p = 0.045). A linear regression model showed that EB remained significantly associated with ModMAS even when controlling for age, race, and treatment group (β = -0.55; 95% CI: -0.8 to -0.3; p = 0.0001). A severity-tailored CBI plus lifestyle coaching significantly improves EB in T2D patients which is associated with significantly improved medication adherence.
D.M. Cummings: None. M. Brown: None. L. Lutes: None. B. Hambidge: None. M.A. Carraway: None. S.P. Patil: Research Support; Self; Novo Nordisk Inc. A. Adams: None. K. Littlewood: None. S.B. Edwards: None. P. Gatlin: None.
Bristol-Myers Squibb Foundation