Actondiabetes-a guided psychological Internet intervention based on acceptance and commitment therapy (ACT) for adults living with type 1 or 2 diabetes: results of a randomised controlled feasibility trial
Open accessAbstract
OBJECTIVES: This two-group randomised controlled trial evaluates the feasibility of an Acceptance and Commitment Therapy (ACT)-based internet intervention for diabetes distress in people with diabetes type 1 or type 2. Participants were assigned to a guided self-help intervention (EG) or waitlist control group (CG). SETTING: Recruitment took place following an open recruitment strategy including different diabetes centres, self-help groups and social media platforms. PARTICIPANTS: Eligibility criteria comprised being 18 years of age or older, self-reported diagnosis of type 1 or type 2 diabetes, internet access, sufficient German language skills and written informed consent. INTERVENTION: ACTonDiabetes is an internet-based and mobile-based intervention and comprises an introduction and seven modules (one module per week, processing time about 45-60 min). Intervention contents are based on ACT. PRIMARY AND SECONDARY OUTCOME MEASURES: Participants were assessed before and 8 weeks after randomisation. Primary outcome was feasibility (trial recruitment, acceptability). Potential group differences in diabetes distress and other outcomes at follow-up were analysed using linear regression models with baseline values as predictors. All analyses were based on an intention-to-treat principle, potential negative effects were analysed on per-protocol basis. RESULTS: From October 2017 to April 2018, N=42 people with diabetes consented and were randomised (EG n=21, CG n=21). Forty-three per cent of the EG completed all treatment modules within 8 weeks. Across modules, formative user feedback revealed that contents could be optimised regarding comprehensibility (34%), individualisation (20%) and text amount (21%). Overall, 57% of participants dropped out prior to full treatment completion. There were reductions of diabetes distress in the EG (d=0.65, p=0.042). CONCLUSIONS: Modifications of the intervention content according to the user feedback will be performed to further improve acceptability. Mechanisms to foster intervention adherence should be considered for lowering the attrition rate. ACTonDiabetes is feasible for the implementation in a confirmatory trial. TRIAL REGISTRATION NUMBER: WHO International Clinical Trials Registry Platform via the German Clinical Trials Register (DRKS) (DRKS00013193).
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An RCT feasibility study of an ACT-based intervention provided in web format included individuals with type 1 and type 2 diabetes, and a reduction in diabetes distress was seen in the intervention group, but the dropout rate was 57% during treatment.
“Furthermore, an RCT feasibility study of an ACT-based intervention provided in web format included individuals with type 1 and type 2 diabetes. A reduction in diabetes distress was seen in the intervention group. However, the dropout rate was 57% during treatment.34”
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Research works printed but not linked: 4
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Konstantinou, P., Ioannou, M., Melanthiou, D., Georgiou, K., Almas, I., Gloster, A. T., Kassianos, A. P., & Karekla, M. (2023) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2023.08.004 · Cited by 53 · see citing works
Alho, I., Lappalainen, P., Muotka, J., & Lappalainen, R. (2022) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2022.08.002 · Cited by 27 · see citing works
Seery, C., & Buchanan, S. (2022) · Journal of Nephrology · doi:10.1007/s40620-022-01437-3 · Cited by 22 · see citing works
Racey, M., Whitmore, C., Alliston, P., Cafazzo, J. A., Crawford, A. S., Castle, D. J., Dragonetti, R., Fitzpatrick‐Lewis, D., Jovkovic, M., Melamed, O. C., et al. (2023) · JMIR Diabetes · doi:10.2196/44652 · Cited by 18 · see citing works
Thiblin, E., Woodford, J., Reuther, C., Lundgren, J., Lutvica, N., & von Essén, L. (2022) · Cancer Medicine · doi:10.1002/cam4.5377 · Cited by 17 · see citing works
Wijk, I., Amsberg, S., Johansson, U.-B., Livheim, F., Toft, E., & Anderbro, T. (2023) · BMJ Open · doi:10.1136/bmjopen-2023-072061 · Cited by 15 · see citing works
Karlsson-Good, M., Kaldo, V., Lundberg, L., Kraepelien, M., Anthony, S. A., & Holländare, F. (2023) · Internet Interventions · doi:10.1016/j.invent.2023.100678 · Cited by 11 · see citing works
Sakane, N., Kato, K., Hata, S., Nishimura, E., Araki, R., Kouyama, K., Hatao, M., Matoba, Y., Matsushita, Y., Domichi, M., et al. (2023) · Internal Medicine · doi:10.2169/internalmedicine.0332-22 · Cited by 11 · see citing works
Thomas, E. B. K., Sagorac Gruichich, T., Maronge, J. M., Hoel, S., Victory, A., Stowe, Z. N., & Cochran, A. (2023) · JMIR Mental Health · doi:10.2196/43065 · Cited by 9 · see citing works
Wicaksana, A. L., Apriliyasari, R. W., & Tsai, P. (2023) · International Journal of Nursing Studies · doi:10.1016/j.ijnurstu.2023.104626 · Cited by 13 · see citing works
Apolinário-Hagen, J., Drüge, M., Guthardt, L., & Haller, E. (2024) · Advances in Experimental Medicine and Biology · doi:10.1007/978-981-97-4402-2_12 · Cited by 6 · see citing works
Lehmann, G., Ziebell, P., SCHMITT, A. J., Kulzer, B., Hermanns, N., & Ehrmann, D. (2023) · Acta Diabetologica · doi:10.1007/s00592-023-02180-2 · Cited by 7 · see citing works
Roberts, M. Z., Scheiber, F. A., Moskovich, A. A., & Merwin, R. M. (2025) · Behavioral Sciences · doi:10.3390/bs15060792 · Cited by 7 · see citing works
Patton, S. R., Pierce, J. S., Kahhan, N. A., Benson, M. R., Clements, M. A., & Fox, L. A. (2024) · Children · doi:10.3390/children11101169 · Cited by 5 · see citing works
Gityamwi, N., Armes, J., Harris, J., Ream, E., Green, R., Ahankari, A. S., Callwood, A., Ip, A., Cockle‐Hearne, J., Grosvenor, W., et al. (2025) · PLOS Digital Health · doi:10.1371/journal.pdig.0000806 · Cited by 4 · see citing works
Acceptability of ACT group intervention for adolescents with type 1 diabetes
Alho, I., Lappalainen, P., & Lappalainen, R. I. (2024) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2024.100722 · Cited by 5 · see citing works
Richter, C., Rutschmann, R., & Romanczuk‐Seiferth, N. (2024) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2024.1235067 · Cited by 4 · see citing works
Bendig, E., SCHMITT, A. J., Wittenberg, A., Kulzer, B., Hermanns, N., Moshagen, M., & Baumeister, H. (2022) · BMJ Open · doi:10.1136/bmjopen-2021-059336 · Cited by 4 · see citing works
Milani, I., Dextre, G. A. L. C., Elisei, R. F., Ripa, P., Capatti, S. R., Magon, A., Cilluffo, S., Terzoni, S., Lusignani, M., Petralito, M., et al. (2025) · Acta Diabetologica · doi:10.1007/s00592-025-02580-6 · Cited by 4 · see citing works
Sims, S., Stenov, V., Due‐Christensen, M., Fisher, L., Fabian-Therond, C., Peck, M., Ahuja, S., O’Connor, S., Abrams, R., Halliday, J., et al. (2026) · Diabetic Medicine · doi:10.1111/dme.70242 · Cited by 3 · see citing works
Schipper, S. B. J., Karagiannis, T., Zaccardi, F., Remmelzwaal, S., Blom, M. T., Dagan, N., Schoonmade, L. J., Langendam, M. W., Mb, J., Jensen, W., et al. (2026) · Diabetologia · doi:10.1007/s00125-026-06789-0 · Cited by 3 · see citing works
Knauer, J., Baumeister, H., Schmitt, A., & Terhorst, Y. (2024) · Frontiers in Digital Health · doi:10.3389/fdgth.2024.1352762 · Cited by 2 · see citing works
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ghayuomi, P., Dioulagh, A. S., Khademi, A., & Aghamohammadzadeh, N. (2025) · Zahedan Journal of Research in Medical Sciences · doi:10.5812/zjrms-165397 · Cited by 2 · see citing works
فعالية العلاج بالتقبل والالتزام لذوي المرض المزمن (مرض السكري أنموذجا)
السويهري, س. س. (2023) · Mağallaẗ Al-Qirā'aẗ wa Al-Maʿrifaẗ/Mağallaẗ Al-Qirā'aẗ wa Al-Maʿrifaẗ · doi:10.21608/mrk.2023.281211
رزق, ع. ح. م. (2022) · مجلة التربية الخاصة · doi:10.21608/mtkh.2022.283506
Geirhos, A., Bendig, E., SCHMITT, A. J., Ebert, D. D., & Baumeister, H. (2023) · Springer eBooks · doi:10.1007/978-3-662-65816-1_16
Susila, W. D. C., Nurwahidah, N., & Metrikayanto, W. D. (2023) · Adi Husada Nursing Journal · doi:10.37036/ahnj.v9i1.385
Elyeli, K., & Esmaeilzadeh, S. (2026) · CIN Computers Informatics Nursing · doi:10.1097/cin.0000000000001334
Schmidt, T., Just‐Østergaard, E., Mouritsen, J. D., Pedersen, G. S., Pouwer, F., & Juhl, C. B. (2026) · Diabetic Medicine · doi:10.1111/dme.70357
Navigating the digital health landscape in U.S. adults with diabetes
Burroughs, T. E., Varghese, B., Hirsch, I. B., Loux, T. M., Shacham, E., & Rozier, M. D. (2026) · Primary care diabetes · doi:10.1016/j.pcd.2026.06.002
- Authors
- Bendig, E., Bauereiss, N., Schmitt, A., Albus, P., & Baumeister, H.
- Affiliations
- Universität Ulm (DE)
- Forschungsinstitut der Diabetes Akademie Mergentheim (DE)
- Corresponding author
- Bendig, Eileen
- Venue
- BMJ Open
- Publisher
- BMJ
- Published
- 2021-07
- Volume
- 11
- Issue
- 7
- Pages
- e049238
- ISSN
- 2044-6055 (ISSN-L)
- PMC
- PMC8273455
- OpenAlex
- W3178213102
- Cited by
- 31
- References
- 101
- Citations by year
- 2026: 5 · 2025: 4 · 2024: 5 · 2023: 12 · 2022: 5
- FWCI
- 4.94
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- BMJ Open (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Topics
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
- Keywords
- acceptance and commitment therapy, diabetes distress, type 1 diabetes, type 2 diabetes, online psychological intervention, guided self-help, feasibility, acceptability, user feedback, intervention adherence, attrition, mobile-based interventions
- MeSH terms
- Internet-Based Intervention, Adolescent, Adult, Diabetes Mellitus, Type 1, Diabetes Mellitus, Type 2, Feasibility Studies, Humans, Treatment Outcome, Internet, Acceptance and Commitment Therapy
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