Do the effects of psychological treatments on improving glycemic control in type 1 diabetes persist over time? A long-term follow-up of a randomized controlled trial

Katie Ridge, Jonathan Bartlett, Yee Cheah, Stephen Thomas, Geoffrey Lawrence-Smith, Kirsty Winkley, Khalida Ismail

Research output: Contribution to journalArticlepeer-review

15 Citations (Scopus)

Abstract

OBJECTIVES: In a randomized controlled trial, adults with Type 1 diabetes and suboptimal glycemic control who received motivational enhancement therapy (MET) plus cognitive behavioral therapy (CBT) had a greater reduction in their 12-month hemoglobin A(1c) (Hb(A1c)) than those who received usual care (UC). We tested whether improvements in glycemic control persisted up to 4 years after randomization.

METHODS: In the original trial, participants were randomized to UC (n = 121), 4 sessions of MET (n = 117), or 4 sessions of MET plus 8 sessions of CBT (n = 106). Of the 344 patients who participated in the original trial, 260 (75.6%) consented to take part in this posttrial study. A linear mixed model was fitted to available measurements to assess whether intervention effects on Hb(A1c) at 12 months were sustained at 2, 3, and 4 years.

RESULTS: Estimated mean Hb(A1c) level was lower for participants in the two intervention arms when compared with UC at 2, 3, and 4 years, but none of the differences were statistically significant. At 4 years, estimated mean Hb(A1c) level for MET plus CBT was 0.28% (95% confidence interval = -0.22% to 0.77%) lower than that for UC, and estimated mean Hb(A1c) level for MET was 0.17% (95% confidence interval = -0.33% to 0.66%) lower than that for UC.

CONCLUSIONS: There was no evidence of benefit for patients randomized to MET plus CBT at 2, 3, or 4 years. Larger studies are needed to estimate long-term treatment effects with greater precision. Current models of psychological treatments in diabetes may need to be intensified or include maintenance sessions to maintain improvements in glycemic control.

Original languageEnglish
Pages (from-to)319-323
Number of pages5
JournalPsychosomatic Medicine
Volume74
Issue number3
Early online date20 Mar 2012
DOIs
Publication statusPublished - 1 Apr 2012

Keywords

  • Adolescent
  • Adult
  • Cognitive Therapy
  • Combined Modality Therapy
  • Confidence Intervals
  • Diabetes Mellitus, Type 1/blood
  • Female
  • Follow-Up Studies
  • Glycated Hemoglobin A/metabolism
  • Humans
  • Linear Models
  • Male
  • Motivation
  • Nursing Care/methods
  • Patient Compliance
  • Self Care/psychology
  • Time Factors
  • Treatment Outcome

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