A cognitive behavior therapy-based intervention among poorly controlled adult type 1 diabetes patients—A randomized controlled trial
Abstract
Objective To examine the impact of a Cognitive Behavior Therapy (CBT)-based intervention on HbA(1c), self-care behaviors and psychosocial factors among poorly controlled adult type 1 diabetes patients.Methods Ninety-four type 1 diabetes patients were randomly assigned to either an intervention group or a control group. The intervention was based on CBT and was mainly delivered in group format, but individual sessions were also included. All subjects were provided with a continuous glucose monitoring system (CGMS) during two 3-day periods. HbA(1c), self-care behaviors and psychosocial factors were measured up to 48 weeks.Results Significant differences were observed with respect to HbA(1c) (P<0.05), well-being (P<0.05), diabetes-related distress (P<0.01), frequency of blood glucose testing (P<0.05), avoidance of hypoglycemia (P<0.01), perceived stress (P<0.05), anxiety (P<0.05) and depression (P<0.05), all of which showed greater improvement in the intervention group compared with the control group. A significant difference (P<0.05) was registered with respect to non-severe hypoglycemia, which yielded a higher score in the intervention group.Conclusion This CBT-based intervention appears to be a promising approach to diabetes self-management.Practice implications Diabetes care may benefit from applying tools commonly used in CBT. For further scientific evaluation in clinical practice, there is a need for specially educated diabetes care teams, trained in the current approach, as well as cooperation between diabetes care teams and psychologists trained in CBT.
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In an RCT by Amsberg et al, a CBT intervention improved HbA1c and reduced levels of depression and diabetes distress.
“In a randomised controlled trial (RCT) by Amsberg et al, a CBT intervention improved HbA1c and reduced levels of depression and diabetes distress.25”
The Swedish version of SDSCA has Cronbach's alpha for the subscales ranging from 0.80 to 0.86.
“Cronbach’s alpha for the subscales ranged from 0.80 to 0.86.9”
From Acceptance and commitment therapy (ACT) for adult type 1 diabetes management: Study protocol for a randomised controlled trial (2018) · cites this paper as [9]
Our own previous treatment study was the first to demonstrate statistically assured effects on HbA1c.
“Our own previous treatment study in the field9 10 was the first to demonstrate statistically assured effects on HbA1c.”
From Acceptance and commitment therapy (ACT) for adult type 1 diabetes management: Study protocol for a randomised controlled trial (2018) · cites this paper as [9]
Newer intervention approaches integrate psychological treatments with exercise training, nurse-led self-management support, and nurse-, dietitian-, and mental health-specialist-delivered self-management interventions.
“These include interventions that integrate psychological treatments with exercise training (20), nurse-led self-management support (21), and nurse-, dietitian-, and mental health-specialist–delivered self-management interventions (22).”
From Depression in diabetes: have we been missing something important? (2011) · cites this paper as [22]
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References 53 · Cited by 107
- Authors
- Amsberg, S., Anderbro, T., Wredling, R., Lisspers, J., Lins, P.-E., Adamson, U., & Johansson, U.-B.
- Affiliations
- Sophiahemmet University College (SE)
- Karolinska Institutet (SE)
- Mid Sweden University (SE)
- Venue
- Patient Education and Counseling
- Publisher
- Elsevier BV
- Published
- 2009-10
- Volume
- 77
- Issue
- 1
- Pages
- 72-80
- ISSN
- 0738-3991 (ISSN-L)
- OpenAlex
- W1988174490
- Cited by
- 107
- References
- 53
- Citations by year
- 2026: 2 · 2025: 2 · 2024: 5 · 2023: 8 · 2022: 8 · 2021: 6 · 2020: 10 · 2019: 3 · 2018: 3 · 2017: 5 · 2016: 6 · 2015: 14 · 2014: 7 · 2013: 9 · 2012: 6
- FWCI
- 4.60
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Patient Education and Counseling (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- cognitive behavioral therapy, type 1 diabetes, poor glycemic control, diabetes self-management, HbA1c, diabetes distress, hypoglycemia, blood glucose monitoring, perceived stress, anxiety, depression, continuous glucose monitoring, psychosocial factors
- MeSH terms
- Adult, Aged, Analysis of Variance, Diabetes Mellitus, Type 1, Female, Glycated Hemoglobin, Humans, Male, Middle Aged, Self Care, Blood Glucose Self-Monitoring, Cognitive Behavioral Therapy, Confidence Intervals, Disease Progression
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