Introduction and Objective: We asked how a diabetes distress (DD) intervention fostered changes in diabetes-related emotion management, diabetes problem solving, and HbA1C; and to test a hypothesized 4-Stage, sequential pathway whereby reductions in DD were linked with improved glycemic outcomes.Methods: PWDs with T1D (n=276) with elevated DD and HbA1cwere assigned to: StreamLine, a diabetes self-management program; TunedIn, an ACT-based (Acceptance and Commitment Therapy), emotion-focused DD program; or FixIt, an integration of Streamline and TunedIn. 12-month changes in DD (Stage 1), diabetes-related emotion management (Stage 2), diabetes-related problem solving (Stage 3), and HbA1C (Stage 4) were each evaluated. A structural equation model was then specified to evaluate the hypothesized 4-Stage sequence of change over time.Results: Improvements occurred in all 3 groups at all 4 stages. However, TunedIn and FixIt, compared to StreamLine, displayed significantly greater improvements in Stages 1, 2 and 3; while StreamLine and TunedIn displayed greater improvements in HbA1C (Stage 4) than FixIt. The structural equation model supported the hypothesized 4-Stage sequence, such that associations between reductions in DD and glycemic change were explained through improvements in emotion management and problem solving. Two plausible, alternative models also were tested: reversing Stages 1 and 2; reversing stages 3 and 4. In both cases, the model fit indices indicated worse fit, thus supporting the original 4-Stage model.Conclusion: Overall, TunedIn an emotion-focused intervention, demonstrated the most comprehensive, impactful intervention benefits. The model demonstrated how reductions in DD are linked with improved glycemic outcomes through changes in emotion management, which then allow for improved diabetes-related problem solving. This sequence can assist in designing effective intervention programs to reduce DD and improve overall diabetes management.
L. Fisher: None. S. Guzman: Consultant; Abbott. W.H. Polonsky: Consultant; Abbott. Research Support; Abbott. Consultant; Dexcom, Inc. Research Support; Dexcom, Inc. Other Relationship; Ascensia Diabetes Care. L.A. Strycker: None. K. Greenberg: None. D.M. Hessler: None.
Diabetes and Digestive and Kidney Diseases (R01DK121241)
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