Cited by 91Diabetes Management and EducationDiabetes Management and ResearchBehavioral Health and Interventions

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Motivational Enhancement Therapy with and without Cognitive Behavior Therapy to Treat Type 1 Diabetes: A Randomized Trial

Ismail, Khalida, Thomas, Stephen M., Maissi, Esther, Chalder, Trudie, Schmidt, Ulrike, Bartlett, Jonathan, Patel, Anita, Dickens, Christopher M., Creed, Francis, Treasure, Janet·2008·Annals of Internal Medicine

DOI 10.7326/0003-4819-149-10-200811180-00005

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Abstract

BACKGROUND: Although psychological issues can interfere with diabetes care, the effectiveness of psychological treatments in improving diabetes outcomes is uncertain. OBJECTIVE: To determine whether motivational enhancement therapy with or without cognitive behavior therapy improves glycemic control in type 1 diabetes compared with usual care. DESIGN: Randomized, controlled trial. SETTING: 8 diabetes centers in London and Manchester, United Kingdom. PATIENTS: 344 adults with type 1 diabetes for longer than 2 years, with hemoglobin A(1c) levels of 8.2% to 15%, and without complications or severe comorbid disease. INTERVENTION: Nurse-delivered motivational enhancement therapy (4 sessions over 2 months), motivational enhancement therapy plus cognitive behavior therapy (12 sessions over 6 months), or usual care. MEASUREMENTS: 12-month change in hemoglobin A(1c) levels (primary outcome), hypoglycemic events, depression, quality of life, fear of hypoglycemia, diabetes self-care activities, and body mass index (secondary outcomes). RESULTS: In an analysis including all randomly assigned patients, the 12-month change in hemoglobin A(1c) levels compared with usual care was -0.46% (95% CI, -0.81% to -0.11%) in the motivational enhancement therapy plus cognitive behavior therapy group and -0.19% (CI, -0.53% to 0.16%) in the motivational enhancement therapy group alone. There was no evidence of treatment effects on secondary outcomes. LIMITATIONS: Of 1659 screened patients, only 507 were eligible and 344 participated. Data on the primary outcome were unavailable for 11.3% of the participants. Study design did not permit distinction of the additive effect of cognitive behavior therapy plus motivational enhancement therapy from the effect of greater intensity and duration of the combined intervention compared with the motivational enhancement therapy alone. CONCLUSION: Nurse-delivered motivational enhancement therapy and cognitive behavior therapy is feasible for adults with poorly controlled type 1 diabetes. Combined therapy results in modest 12-month improvement in hemoglobin A(1c) levels compared with usual care, but motivational enhancement therapy alone does not.

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A protocol for a pilot randomized controlled trial to assess the feasibility and effect of a cognitive behavioral intervention on quality of life for patients on hemodialysis
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Effect of Motivational Interviewing on Adherence to Treatment in Patients with Hypertension
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Diabetes: glycaemic control in type 1.
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EFFECT OF COGNITIVE THERAPY ON MENTAL HEALTH IN PATIENTS WITH HEART FAILURE
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“As a result, upon testing, results reveal the average of blood glucose over a time period of three (3) months, which is the one-hundred twenty (120) -day lifespan of the RBC (Goldstein et al. 2008; Ismail et al. 2008; Utz et al. 2008).”
Background
Psychiatric Disorders and Diabetes
Holt, R. I. G., & Citrome, L. (2016) · Wiley eBooks · doi:10.1002/9781118924853.ch57 · Cited by 4
Diabetes: finding “a clean well-lighted place”
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Behavior change intervention and fear of hypoglycemia in type 1 diabetes
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Handling Insulin-Related Emotions
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“Randomized controlled trials of robust design [5] and exhaustive systematic reviews and metaanalyses [6] have shown that cognitive behavioral therapy and other psychological interventions can improve glycemic control in both type 2 and type 1 [7] diabetes.”
Background
Trends in baseline HbA1c and body-mass index in randomised trials of people with type 1 diabetes from 1993 to 2025: an IMI2 SOPHIA systematic review and meta-analysis
van Laar, A., Gallardo‐Nuell, L., Pazmiño, S., Visser, M. M., Mertens, A. C., Vangoitsenhoven, R., Gillard, P., Al‐Ozairi, E., le Roux, C. W., Rosen, J., et al. (2025) · EClinicalMedicine · doi:10.1016/j.eclinm.2025.103589 · Cited by 4
Management of diabetes: latest guidance from SIGN
Grant, P. S. (2010) · Nurse Prescribing · doi:10.12968/npre.2010.8.7.48938 · Cited by 2
Psychosocial and Behavioural Aspects of Diabetes
Pouwer, F., & Speight, J. (2024) · Wiley eBooks · doi:10.1002/9781119697473.ch63 · Cited by 2
Motivating the Kidney Disease Patient to Nutrition Adherence and Other Healthy Lifestyle Activities
Martino, S., Chwastiak, L., & Finkelstein, F. O. (2012) · Elsevier eBooks · doi:10.1016/b978-0-12-391934-2.00046-1 · Cited by 1
Effects of motivational interviewing on HbA1c and depression among cases with type 1 diabetes: a meta-analysis
Chen, Y., Tian, Y., Sun, X., Zhang, F., & Huang, X. D. (2021) · International Journal of Diabetes in Developing Countries · doi:10.1007/s13410-021-01003-w · Cited by 1
COGNITIVE THERAPY FOR THE TREATMENT OF DEPRESSIVE SYMPTOMS IN PATIENTS WITH HEART FAILURE
Dekker, R. L. (2010) · UKnowledge (University of Kentucky)
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Psychologic Factors and Diabetes
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Psykologisk behandling ved diabetes
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Diabetes Mellitus
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The Effects of Learning Mindfulness Based Stress Reduction on Psychosocial Variables and HbA1c in Adolescents with Type 1 Diabetes
Smith, D. V. S. (2019)
Psychiatric Disorders and Diabetes
Peveler, R., & Holt, R. I. G. (2010) · doi:10.1002/9781444324808.ch55
Motivating the patient with kidney disease to nutrition adherence and other healthy lifestyle activities
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Rehnstedt, A., & Säll, B.-M. (2009) · DiVA (University of Gävle)
Utilization obstacles to hypertension services provided at comprehensive health centers: a content analysis study
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“These techniques have been used in recent years to increase adherence to treatment, improve nutrition, and promote physical activity in people with diabetes [24], chronic obstructive pulmonary disease [25], and hypertension [26].”
Method
Mental Disorders and Diabetes
Siddiqi, N., Stadler, M., & Holt, R. I. G. (2024) · Wiley eBooks · doi:10.1002/9781119697473.ch65
Motivational Enhancement Therapy for Perfectionism
Vala, K. C., Cannon, B. J., & Schwartz, R. M. (2025) · Counseling Outcome Research and Evaluation · doi:10.1080/21501378.2025.2454583
“Given that both MI and MET have been effective for a wide array of concerns, the present study anticipated that MET would be beneficial for individuals with perfectionism (Buckner & Schmidt, 2009; Dunn et al., 2006; Fields, 2006; Ismail et al., 2008; Lundahl & Burke, 2009; Walker et al., 2006).”
Behavior Change Counseling Strategies (BCC) as an Effective Treatment Approach Along with Insulin Regimens for Type1 Young Adult Diabetes Mellitus Patients from a Busy Diabetic Clinic—A Randomized Single-Blinded Controlled Trial: Pilot Study
Unni, S. R., Harthy, S. A., Singh, J., & McCallum, M. (2025) · Journal of Diabetes and Endocrine Practice · doi:10.1055/s-0045-1808263

Authors: Ismail, K., Thomas, S. M., Maissi, E., Chalder, T., Schmidt, U., Bartlett, J., Patel, A., Dickens, C. M., Creed, F., & Treasure, J.
Affiliations: St Thomas' Hospital (GB)
From King's College London, Guy's and St Thomas' Hospitals, and London School of Hygiene & Tropical Medicine, London, United Kingdom, and the University of Manchester, Manchester, United Kingdom.
ORCID: Ismail, Khalida
Chalder, Trudie
Schmidt, Ulrike
Bartlett, Jonathan
Patel, Anita
Creed, Francis
Treasure, Janet
Venue: Annals of Internal Medicine
Publisher: American College of Physicians
Published: 2008-11-18
Volume: 149
Issue: 10
Pages: 708-719
ISSN: 0003-4819 (ISSN-L)
1539-3704
DOI: 10.7326/0003-4819-149-10-200811180-00005
OpenAlex: W2004352160
Cited by: 91
References: 48
Citations by year: 2025: 3 · 2024: 5 · 2023: 2 · 2022: 1 · 2021: 4 · 2020: 3 · 2019: 3 · 2018: 8 · 2017: 3 · 2016: 4 · 2015: 10 · 2014: 4 · 2013: 5 · 2012: 8
FWCI: 6.75
Type: journal article
Language: en
Open access: closed
Licence: www.acpjournals.org/journal/aim/text-and-data-mining (tdm)
Locations: Annals of Internal Medicine (publishedVersion)
PubMed (publishedVersion)
Research Portal (King's College London) (submittedVersion)
Research Explorer (The University of Manchester) (submittedVersion)
Funders: National Institute for Health and Care Research (01/17/05)
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 › Applied Psychology › Behavioral Health and Interventions
Keywords: type 1 diabetes, motivational enhancement therapy, cognitive behavioral therapy, glycemic control, HbA1c, psychological intervention, hypoglycemia, diabetes self-care, depression, quality of life, fear of hypoglycemia
MeSH terms: Adult, Aged, Combined Modality Therapy, Depression, Diabetes Mellitus, Type 1, Female, Glycated Hemoglobin, Humans, Hypoglycemia, Hypoglycemic Agents, Insulin, Male, Middle Aged, Motivation, Nursing Care, Sensitivity and Specificity, Cognitive Behavioral Therapy, Young Adult

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Motivational Enhancement Therapy with and without Cognitive Behavior Therapy to Treat Type 1 Diabetes: A Randomized Trial

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