T1-REDEEM: A Randomized Controlled Trial to Reduce Diabetes Distress Among Adults With Type 1 Diabetes

Lawrence Fisher, Danielle Hessler, William H. Polonsky, Umesh Masharani, Susan Guzman, Vicky Bowyer, Lisa Strycker, Andrew Ahmann, Marina Basina, Ian Blumer, Charles Chloe, Sarah Kim, Anne L. Peters, Martha Shumway, Karen L Weihs, Patricia Wu

Research output: Contribution to journalArticle

22 Scopus citations

Abstract

OBJECTIVE: To compare the effectiveness of two interventions to reduce diabetes distress (DD) and improve glycemic control among adults with type 1 diabetes (T1D).

RESEARCH DESIGN AND METHODS: Individuals with T1D (n = 301) with elevated DD and HbA1c were recruited from multiple settings and randomly assigned to OnTrack, an emotion-focused intervention, or to KnowIt, an educational/behavioral intervention. Each group attended a full-day workshop plus four online meetings over 3 months. Assessments occurred at baseline and 3 and 9 months. Primary and secondary outcomes were change in DD and change in HbA1c, respectively.

RESULTS: With 12% attrition, both groups demonstrated dramatic reductions in DD (effect size d = 1.06; 78.4% demonstrated a reduction of at least one minimal clinically important difference). There were, however, no significant differences in DD reduction between OnTrack and KnowIt. Moderator analyses indicated that OnTrack provided greater DD reduction to those with initially poorer cognitive or emotion regulation skills, higher baseline DD, or greater initial diabetes knowledge than those in KnowIt. Significant but modest reductions in HbA1c occurred with no between-group differences. Change in DD was modestly associated with change in HbA1c (r = 0.14, P = 0.01), with no significant between-group differences.

CONCLUSIONS: DD can be successfully reduced among distressed individuals with T1D with elevated HbA1c using both education/behavioral and emotion-focused approaches. Reductions in DD are only modestly associated with reductions in HbA1c. These findings point to the importance of tailoring interventions to address affective, knowledge, and cognitive skills when intervening to reduce DD and improve glycemic control.

Original languageEnglish (US)
Pages (from-to)1862-1869
Number of pages8
JournalDiabetes Care
Volume41
Issue number9
DOIs
StatePublished - Sep 1 2018

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Advanced and Specialized Nursing

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    Fisher, L., Hessler, D., Polonsky, W. H., Masharani, U., Guzman, S., Bowyer, V., Strycker, L., Ahmann, A., Basina, M., Blumer, I., Chloe, C., Kim, S., Peters, A. L., Shumway, M., Weihs, K. L., & Wu, P. (2018). T1-REDEEM: A Randomized Controlled Trial to Reduce Diabetes Distress Among Adults With Type 1 Diabetes. Diabetes Care, 41(9), 1862-1869. https://doi.org/10.2337/dc18-0391