Introduction: Diabetes distress (DD) is associated with poorer health outcomes in diabetes mellitus (DM). Addressing DD through diabetes education improves glycaemic control. However, few studies have examined the effects of psychological therapy on DD and physical health outcomes, especially in low socioeconomic populations.
Methods: This study examines the impact of intervention by a clinical psychologist as part of a multidisciplinary team (MDT) on glycaemic control, hospital presentations and admissions, DD, and psychological factors. Participants were 50 outpatients aged 17-67 at a public hospital diabetes service in a socioeconomically disadvantaged area of Sydney, Australia. Inclusion criteria were DD, indicated by a PAID score ≥ 40, together with either 1) recent diabetes-related hospitalisation, 2) high HbA1c or 3) conflict over diabetes management. Measures used at baseline and treatment completion were the PAID, the 21-item Depression, Anxiety, Stress Scale (DASS-21), HbA1c, and number of emergency department presentations and hospital admissions in the three months before and after treatment commencement.
Results: All psychological variables showed a significant reduction: DD measured by PAID scores decreased by 36.8% from 57 to 36 (p<0.001); DASS21 scores showed depression reduced by 36.4 % from 11 to 7 (p<0.0001), anxiety by 33.4% from 10 to 6 (p<0.0001) and stress by 16.7% from 12 to 10 (p<0.0002). HbA1c decreased from 9.0% pre-treatment to 8.2% in the three months after treatment commenced. For 25 participants with matched pre and post treatment HbA1cs, mean HbA1c reduction was 0.7% (95% CI 0.1-1.3, p = 0.02). Emergency department presentations halved from 22% (11/50) of participants in the pre- treatment 3 months to 10% (5/50) in the 3 months post treatment. Hospital admissions halved, from 8% (4/49) to 4% (2/49).
Conclusion: This study provides preliminary evidence that treatment by a clinical psychologist can improve health outcomes for people with diabetes.
V.M. Croker: None. C. Calderwood: None. S. Hayes: None. E. Hibbert: None.