In the Journals

Cognitive behavioral therapy reduces HbA1c, distress levels in type 2 diabetes

Adults with type 2 diabetes may be able to achieve improved HbA1c levels and reduce depressive and distress symptoms when treated with personalized cognitive behavioral therapy, according to findings published in Diabetes Care.

Doyle Cummings

“Increasingly, medical and behavioral health colleagues, along with other team members, are working together in busy primary care settings to provide more comprehensive integrated care delivery,” Doyle Cummings, PharmD, FCP, FCCP, Berbecker Distinguished Professor of Rural Medicine, professor of family medicine and public health and co-director of the Research Core at the Health Disparities Center of the East Carolina University Brody School of Medicine in Greenville, North Carolina, told Endocrine Today. “The present study demonstrates that the use of this integrated and tailored behavioral treatment is possible in busy primary care settings, where most care for patients with type 2 diabetes occurs and can result in improved care outcomes that have the potential to impact the increased risk of complications.”

Cummings and colleagues conducted a 12-month randomized controlled trial with 139 adults with type 2 diabetes (mean age, 52.6 years; 77.7% women; mean HbA1c, 9.6%) and the presence of depressive symptoms. Participants were recruited in a rural area, according to the researchers. At baseline, screenings for distress symptoms and depressive symptoms were measured based on the Diabetes Distress Scale-2 and the Patient Health Questionnaire-2, respectively.

Participants were randomly assigned to the intervention treatment or standard care during the trial. The intervention treatment included cognitive behavioral therapy or small-changes lifestyle coaching depending on the severity of the depressive and distress symptoms. The cognitive behavioral therapy included 12 individual sessions in which reducing depressive and distress symptoms and improving diabetes management were addressed. At 6 months, all participants were assessed and assigned to a new form of treatment if necessary. For example, participants who reported increased depressive symptoms after receiving only small-changes lifestyle coaching were reassigned to the cognitive behavioral therapy group.

HbA1c levels dropped by an average of 0.92% in the intervention group compared with a decline of 0.31% in the standard-care group, although the researchers noted that this measure did not reach stastical significance. However, regimen-related distress (P = .001) and depressive symptoms (P = .01) declined while self-care behaviors (P = .03) and medication adherence (P = .02) improved in the intervention group compared with the standard-care group. The researchers also found a correlation between lowered HbA1c levels and improvements in regimen-related distress (P = .0001) and medication adherence (P = .007).

“Given the complexities and interacting relationships of glycemic control, engagement in diabetes self-care activities, and mental health concerns, these findings emphasize the need for a more integrated approach involving providers from multiple disciplines as well as [community health workers],” the researchers wrote. – by Phil Neuffer

Disclosures: Cummings reports he has served as co-investigator on a study that was funded by Novo Nordisk. Please see the study for all other authors’ relevant financial disclosures.

Adults with type 2 diabetes may be able to achieve improved HbA1c levels and reduce depressive and distress symptoms when treated with personalized cognitive behavioral therapy, according to findings published in Diabetes Care.

Doyle Cummings

“Increasingly, medical and behavioral health colleagues, along with other team members, are working together in busy primary care settings to provide more comprehensive integrated care delivery,” Doyle Cummings, PharmD, FCP, FCCP, Berbecker Distinguished Professor of Rural Medicine, professor of family medicine and public health and co-director of the Research Core at the Health Disparities Center of the East Carolina University Brody School of Medicine in Greenville, North Carolina, told Endocrine Today. “The present study demonstrates that the use of this integrated and tailored behavioral treatment is possible in busy primary care settings, where most care for patients with type 2 diabetes occurs and can result in improved care outcomes that have the potential to impact the increased risk of complications.”

Cummings and colleagues conducted a 12-month randomized controlled trial with 139 adults with type 2 diabetes (mean age, 52.6 years; 77.7% women; mean HbA1c, 9.6%) and the presence of depressive symptoms. Participants were recruited in a rural area, according to the researchers. At baseline, screenings for distress symptoms and depressive symptoms were measured based on the Diabetes Distress Scale-2 and the Patient Health Questionnaire-2, respectively.

Participants were randomly assigned to the intervention treatment or standard care during the trial. The intervention treatment included cognitive behavioral therapy or small-changes lifestyle coaching depending on the severity of the depressive and distress symptoms. The cognitive behavioral therapy included 12 individual sessions in which reducing depressive and distress symptoms and improving diabetes management were addressed. At 6 months, all participants were assessed and assigned to a new form of treatment if necessary. For example, participants who reported increased depressive symptoms after receiving only small-changes lifestyle coaching were reassigned to the cognitive behavioral therapy group.

HbA1c levels dropped by an average of 0.92% in the intervention group compared with a decline of 0.31% in the standard-care group, although the researchers noted that this measure did not reach stastical significance. However, regimen-related distress (P = .001) and depressive symptoms (P = .01) declined while self-care behaviors (P = .03) and medication adherence (P = .02) improved in the intervention group compared with the standard-care group. The researchers also found a correlation between lowered HbA1c levels and improvements in regimen-related distress (P = .0001) and medication adherence (P = .007).

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“Given the complexities and interacting relationships of glycemic control, engagement in diabetes self-care activities, and mental health concerns, these findings emphasize the need for a more integrated approach involving providers from multiple disciplines as well as [community health workers],” the researchers wrote. – by Phil Neuffer

Disclosures: Cummings reports he has served as co-investigator on a study that was funded by Novo Nordisk. Please see the study for all other authors’ relevant financial disclosures.