ADA 2023 NEWS: Behavioural health interventions positively impact people experiencing diabetes distress

Results from two studies evaluating the impact of mental health support for people with diabetes found significant benefits in patient outcomes.

As the number of diabetes cases continues to rise, addressing mental health challenges is a critical element in helping individuals with diabetes manage their care plan.

Diabetes distress for example includes the fears, worries, and burdens associated with the diabetes experience. Diabetes distress, which is distinct from depression, is common among adults with type 1 diabetes.

In fact, in any 18-month period, 33 per cent to 50 per cent of people with diabetes experience heightened levels of diabetes distress.

Individuals living with diabetes are also up to three times more likely to have depression than people without diabetes.

Furthermore, only 25 per cent to 50 percent of people with diabetes who have depression get diagnosed and treated. This points to a need to provide proactive behavioural health support as part of the overall care plan.

“People with type 1 diabetes are at a heightened risk for mental health issues, including diabetes distress, depression, anxiety, and disordered eating. However, these are all treatable disorders that can be addressed with personalised treatment plans that go beyond the physical symptoms,” said Robert Gabbay, MD, PhD, chief scientific and medical officer for the ADA. “I’m encouraged by the findings from the studies presented during this year’s Scientific Sessions as we continue to seek out innovative, evidence-based solutions that support people living with diabetes when they need it the most.”

Results from the randomized, controlled EMBARK clinical trial revealed significant reductions in diabetes distress, among adults with type 1 diabetes through three intervention programs.

The EMBARK trial included 300 adults with type 1 diabetes and elevated distress. Individuals were randomly assigned to receive one of three intervention programs: (1) Streamline, an educator-led education and management program; (2) TunedIn, a psychologist-led program focused exclusively on reducing diabetes distress; or (3) FixIt, an integration of the StreamLine and TunedIn programs. Each intervention was delivered in a group-based, virtual format over a three-to-four-month period, including initial workshops, one-to-one phone calls and follow-up meetings.

The results demonstrated a large and clinically meaningful reduction in diabetes distress across all three study arms at the follow-up assessment with 35 per cent of participants no longer reporting elevated levels of distress at follow-up and 74 per cent of participants reported a clinically important reduction in distress.

The FixIt intervention, which integrated education and emotional diabetes distress-targeted approaches, resulted in the greatest reduction in diabetes distress, followed by TunedIn and Streamline. The reductions in diabetes distress were significantly greater in the FixIt intervention compared to Streamline.

“The preliminary results of the EMBARK trial are promising for people living with T1D who suffer from diabetes distress,” said Danielle Hessler Jones, PhD, Professor and Vice Chair for Research in the Department of Family and Community Medicine at the University of California, San Francisco, and lead investigator. “These findings emphasise the significance of providing comprehensive support that addresses both the educational and emotional needs of individuals living with diabetes.”

The authors of this study will be reporting on 12-month follow up findings later this year to understand if these improvements were maintained alongside glycaemic outcomes. Additionally, there are plans to expand on this work in Diabetes Distress-ASSIST, a new study in which researchers will train clinical teams from 18 diabetes clinics on how to assess and address DD as part of their care delivery.

This research was presented today at the 83rd Scientific Sessions of the American Diabetes Association^® (ADA) in San Diego, CA.