In the Journals Plus

Educational, emotional interventions reduce diabetes distress

Show Citation

July 11, 2018

Lawrence Fisher 2018
Lawrence Fisher

Both educational/behavioral and emotional interventions may aid in reducing diabetes distress among adults with type 1 diabetes, according to a study published in Diabetes Care.

“Significant diabetes distress is highly prevalent and occurs among individuals with and without good glycemic control,” Lawrence Fisher, PhD, professor emeritus in the department of family and community medicine at the University of California, San Francisco, told Endocrine Today. “It affects mood, quality of life, relationships with others, management, etc. Reductions in diabetes distress do not directly lead to improvements in management, but reductions in diabetes distress can assist patients in becoming more responsive to management interventions.”

Between 2014 and 2017, researchers recruited a sample of 301 adults with type 1 diabetes from patient registries, support groups and online diabetes organizations in Arizona, California, Oregon and Canada. All participants had a diagnosis of type 1 diabetes for a minimum of 12 years, a mean item score of at least 2 on the Type 1 Diabetes Distress Scale, and HbA1c at least 7.5%. Researchers randomly assigned patients to an educational/behavioral or an emotional intervention. The educational/behavioral-focused intervention was KnowIt, which was based on a UCSF diabetes education program and included tips for carbohydrate counting and action plans addressing specific topics, such as continuous glucose monitoring (n = 149; mean age, 47.3 years; mean years with diabetes 26.12; 70.5% women). The emotional intervention was OnTrack, which used scenarios and exercises to help patients regulate emotions that arise from having diabetes by providing management strategies and personalized action plans to change behavior (n = 152; mean age, 42.8 years; mean years with diabetes, 23.17; 67.8% women). Both interventions required attendance at a 1-day group workshop and participation in four 1-hour online video meetings with group members and a leader for 3 months. Researchers conducted a follow-up assessment through an online survey and HbA1c testing at 3 and 9 months after the conclusion of the workshop.

Diabetes distress was measured by a 28-item scale with seven subscales: powerlessness, management distress, hypoglycemia distress, negative social perceptions, eating distress, physician distress and family/friend distress. All items ranged from 1 (“not a problem) to 6 (“a very serious problem”).

Researchers assessed emotion regulation with two other scales that examined acceptance of emotion without self-criticism and non-impulsive reactions to emotions. Two cognition scales were also included because emotion regulation and cognition can interact with each other, according to the researchers.

One diabetes knowledge test was administered with the content expanded for information presented in KnowIt.

Researchers found that, among all participants, there was a reduction in total diabetes distress from baseline to 9 months (mean diabetes distress score: 2.88 vs. 2.17; effect size, 1.06; P < .02) and in hypoglycemia distress (2.66 vs. 2.02; effect size, 0.92; P < .003).

Furthermore, 78.4% of all participants showed a reduction of at least one minimal clinically important difference.

Reductions in HbA1c were modest from baseline to 9 months, and researchers found no significant differences in diabetes distress reduction between participants in KnowIt or OnTrack.

“Since diabetes distress is not a comorbidity or complication, and since it is distinct from clinical depression, it should be viewed as a response to living with a demanding, progressive, chronic disease over time,” Fisher said. “Thus, it should be dealt with as part of the care process and not as a reason for referral. Addressing the emotional side of diabetes becomes a crucial aspect of comprehensive diabetes care.” – by Melissa J. Webb

For more information:

Lawrence Fisher, PhD, can be reached at

Researchers are planning to offer OnTrack in San Diego in the fall. Those interested should email with “OnTrack” in the subject line.

Disclosures: The study was funded by the National Institute of Diabetes and Digestive and Kidney Diseases. The authors report no relevant financial disclosures.


itj+ Infographic

itj+ Perspective