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A time‐limited, problem‐orientated psychotherapeutic intervention in Type 1 diabetic patients with complications: a randomized controlled trial
Author(s) -
Didjurgeit U.,
Kruse J.,
Schmitz N.,
Stückenschneider P.,
Sawicki P. T.
Publication year - 2002
Publication title -
diabetic medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.474
H-Index - 145
eISSN - 1464-5491
pISSN - 0742-3071
DOI - 10.1046/j.1464-5491.2002.00811.x
Subject(s) - medicine , psychosocial , randomized controlled trial , diabetes mellitus , intervention (counseling) , type 2 diabetes , type 1 diabetes , metabolic control analysis , physical therapy , pediatrics , endocrinology , psychiatry
Aims To examine the effects of a time‐limited, problem‐orientated psychotherapeutic intervention on self‐defined psychological problems and metabolic control in Type 1 diabetic patients with microvascular complications. Design Randomized wait‐list controlled trial with a follow‐up of 6 months. Setting Out‐patient clinic of a university diabetes centre. Participants Forty‐six Type 1 diabetic patients with intensified insulin therapy and presence of microvascular diabetic complications. Twenty‐four patients were randomly allocated to the intervention group and 22 patients to the control group. Intervention Participation in a structured, problem‐orientated, time‐limited psychotherapeutic intervention (IG). The control group (CG) patients received routine diabetes care in a specialized diabetes university clinic. Outcome measures Degree of change of three self‐defined main psychological and psychosocial problems (no. 1, no. 2 and no. 3) on a 1–10 graded scale and glycosylated haemoglobin HbA 1c values. Results Two patients (one in each group) died during the study period. All remaining patients were followed for 6 months. Problem scores were high at baseline in both groups: IG/CG (mean values, standard deviation in parentheses): problem no. 1, 7.8 (2.0)/8.3 (1.7); problem no. 2, 7.7 (2.3)/7.6 (1.8); and problem no. 3, 7.7 (2.3)/7.4 (2.6). At follow‐up, all problems were significantly lower in the intervention group (IG) when compared with the CG: IG/CG: problem no. 1, 4.3 (2.9)/6.8 (3.0), P = 0.03; problem no. 2, 3.9 (2.4)/5.8 (2.8), P = 0.03; problem no. 3, 4.7 (2.4)/6.8 (2.4), P = 0.02. Mean HbA 1c decreased in the intervention group by 0.6 (1.2)% and increased in the control group by 0.1 (0.7)%, P = 0.016. In patients with suboptimal metabolic control, i.e. HbA 1c > 8%, mean HbA 1c decreased by 1.0 (1.2)% in the IG and increased by 0.1 (0.7)% in the CG, P = 0.011. Conclusion A time‐limited, structured, problem‐orientated psychotherapeutic intervention decreases the severity of psychological problems and improves metabolic control in Type 1 diabetic patients with microvascular complications and self‐management of intensified insulin therapy.