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Managing Distress Improves Life, Health for People With Type 1 Diabetes

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Addressing the emotional burden of living with Type 1 diabetes helps patients improve their mental health and control their glucose levels.

The most effective way to reduce the distress that comes with having Type 1 diabetes—and to improve crucial glucose control—is to focus on managing the mental strain of living with the condition, a recent study has found.

In research published in May in the journal Diabetes Care, this new approach can help people with Type 1 diabetes cope with their disease and improve their emotional state.

A diagnosis of Type 1 diabetes, formerly known as “juvenile diabetes,” can be crushing to receive. Unlike Type 2 diabetes, Type 1 has no cure. Type 1 is an autoimmune disease that often begins in childhood or young adulthood when the pancreas stops functioning properly. People with Type 2 diabetes, which is typically a result of high blood sugar brought on by overeating, can reverse their disease by losing weight and modifying their diet. This is not true of Type 1, which requires lifelong insulin dependence.

People with Type 1 diabetes typically take a while to adjust to the demands of managing their disease, and this can be especially difficult in childhood when the disease is usually diagnosed.

People with diabetes are 2 to 3 times more likely to have depression than people without diabetes, according to the Centers for Disease Control and Prevention, but only 25 percent to 50 percent of people with diabetes who have depression receive diagnosis and treatment for it.

Having Type 1 diabetes also puts people at a heightened risk for anxiety and disordered eating, according to the American Diabetes Association (ADA). However, “These are all treatable disorders that can be addressed with personalized treatment plans that go beyond the physical symptoms,” said Dr. Robert Gabbay, chief scientific and medical officer of the ADA, in an association press release.

Diabetes researchers have coined a term to describe the worries that accompany Type 1 diabetes: “diabetes distress,” or DD. Diabetes distress “refers to the fears, worries and burdens associated with living with and managing diabetes, and it affects up to 75% of adults with Type 1 diabetes,” according to a University of California San Francisco press release about the May DD study.

A Tale of Three Approaches

The DD study, called EMBARK, focused on three established approaches to easing the condition:

  1. Streamline—a traditional, educator-led behavioral program that includes education about managing Type 1 diabetes
  2. TunedIn—a psychologist-led program that focuses exclusively on the emotional components of living with Type 1 diabetes
  3. FixIt—a combination of the Streamline and TunedIn programs

A total of 276 adults (median age 47) with Type 1 diabetes were involved in the study, randomly assigned to the Streamline, TunedIn, or FixIt programs, which were administered virtually. The researchers assessed the participants’ DD and HbA1c (blood glucose) levels at three, six, and 12 months.

While the subjects in all three programs demonstrated “substantive and sustained reductions” in DD after 12 months, TunedIn and FixIt participants “reported significantly greater DD reductions compared with Streamline participants,” stated the researchers. However, the Streamline and TunedIn participants experienced greater HbA1c reductions than did the FixIt participants, they found.

“Although both approaches [educational and emotion-focused] are associated with significant and clinically meaningful reductions in DD and HbA1c, TunedIn, the emotion-focused program, had the most consistent benefits across both DD and HbA1c,” the researchers concluded.

Significantly, half the subjects in the TunedIn group reported no longer having DD at the 12-month follow-up.

Group-based, virtual, emotion-focused DD management strategies are most helpful for adults with Type 1 diabetes, these findings show.

“Most patients with diabetes have never heard of diabetes distress or been asked about it, and don’t understand that it can be alleviated,” said first author Danielle Hessler Jones in a UC San Francisco press release. Ms. Hessler Jones, who has a doctorate in psychology, is a professor and vice chair for research at the UC San Francisco Department of Family and Community Medicine. “Knowing virtual group-based programs are effective presents an opportunity to change that,” she said.

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