A tailored cognitive-behavioural intervention produces comparable reductions in regimen-related distress in adults with type 2 diabetes regardless of insulin use: 12-month outcomes from the COMRADE trial
Abstract
Objectives Our aim in this study was to determine whether a cognitive-behavioural therapy plus small changes lifestyle intervention can produce comparable improvements in insulin users vs patients not using insulin with uncontrolled type 2 diabetes (T2D) and comorbid depressive or regimen-related distress (RRD) symptoms.Methods This study is a secondary analysis of Collaborative Care Management for Distress and Depression in Rural Diabetes Study, a randomized, controlled trial of a 16-session, severity-tailored cognitive-behavioural therapy plus small changes lifestyle intervention compared with usual care. Outcomes included glycated hemoglobin (A1C), regimen-related distress, depression, medication adherence and diabetes self-care. Our investigation provides 2 sets of contrasts: 1) insulin users in the intervention group compared with insulin users in the usual-care group and 2) insulin users compared with noninsulin users in the intervention group only.Results Of the 139 participants, 72 (52%) were using insulin at baseline and had significantly higher levels of A1C (10.2±2.1% vs 8.9±1.6%) and RRD (3.3±1.4 vs 2.8±1.1), and significantly poorer medication adherence (5.2±2.1 days/wk vs 5.5±1.7 days/wk). Intervention patients using insulin exhibited significantly greater reductions in RRD and marginally significant improvements in medication adherence and A1C compared with insulin users in usual care. Within the intervention group, changes in RRD, medication adherence and A1C did not differ significantly by insulin use.Conclusions Tailored cognitive-behavioural therapy with a small-changes lifestyle intervention improved elevated RRD and A1C outcomes at least as effectively in insulin users as non‒insulin users. Future powered studies need to address the role of insulin use in uptake and treatment outcomes.
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In adults with type 2 diabetes and elevated symptoms of distress or depression, cognitive behavioral therapy produced positive benefits for diabetes distress, A1C, and depressive symptoms for up to 1 year.
“An RCT of cognitive behavioral therapy demonstrated positive benefits for diabetes distress, A1C, and depressive symptoms for up to 1 year among adults with type 2 diabetes and elevated symptoms of distress or depression ( 371).”
From 5. Facilitating Positive Health Behaviors and Well-being to Improve Health Outcomes:<i>Standards of Care in Diabetes—2023</i> (2023) · cites this paper as [371]
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- Authors
- Lutes, L. D., Cummings, D. M., Littlewood, K., Le, M. T., Kirian, K., Patil, S., Solar, C., Carraway, M., & Hambidge, B.
- Affiliations
- University of British Columbia (CA)
- East Carolina University (US)
- University of South Florida (US)
- Corresponding author
- Lutes, Lesley D.
- Venue
- Canadian Journal of Diabetes
- Publisher
- Elsevier BV
- Published
- 2020-08
- Volume
- 44
- Issue
- 6
- Pages
- 530-536
- ISSN
- 1499-2671 (ISSN-L)
- OpenAlex
- W3035369488
- Cited by
- 22
- References
- 31
- Citations by year
- 2026: 3 · 2025: 6 · 2024: 6 · 2023: 4 · 2022: 3
- FWCI
- 1.32
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Canadian Journal of Diabetes (publishedVersion)
- PubMed (publishedVersion)
- Funders
- East Carolina University
- Bristol-Myers Squibb Foundation
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Health Sciences › Medicine › Family Practice › Medication Adherence and Compliance
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Keywords
- type 2 diabetes, regimen-related distress, cognitive behavioral therapy, insulin use, medication adherence, HbA1c, depression, diabetes self-care, personalized interventions
- MeSH terms
- Blood Glucose, Cognition Disorders, Depression, Diabetes Mellitus, Type 2, Female, Follow-Up Studies, Glycated Hemoglobin, Humans, Hypoglycemic Agents, Insulin, Life Style, Male, Middle Aged, Prognosis, Self Care, Biomarkers, Cognitive Behavioral Therapy, Medication Adherence
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