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.

“Prior literature suggests that comorbid behavioral problems such as depressive or diabetes-related distress symptoms are common and are associated with poor self-care behaviors and worse intermediate and long-term health outcomes,” Doyle Cummings, PharmD, professor of rural medicine, family medicine and public health in the Brody School of Medicine at East Carolina University in Greenville, North Carolina, and colleagues wrote. “New care strategies are needed for busy primary care settings where [type 2 diabetes] is most commonly managed. In these settings, comorbid behavioral symptoms may go unrecognized, perhaps in part because of unclear strategies for management once the behavioral symptoms are identified.”

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.

“Prior literature suggests that comorbid behavioral problems such as depressive or diabetes-related distress symptoms are common and are associated with poor self-care behaviors and worse intermediate and long-term health outcomes,” Doyle Cummings, PharmD, professor of rural medicine, family medicine and public health in the Brody School of Medicine at East Carolina University in Greenville, North Carolina, and colleagues wrote. “New care strategies are needed for busy primary care settings where [type 2 diabetes] is most commonly managed. In these settings, comorbid behavioral symptoms may go unrecognized, perhaps in part because of unclear strategies for management once the behavioral symptoms are identified.”

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.