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Cognitive behavioural therapy (CBT) compared with blood glucose awareness training (BGAT) in poorly controlled Type 1 diabetic patients: long‐term effects on HbA 1c moderated by depression. A randomized controlled trial
Author(s) -
Snoek F. J.,
Van Der Ven N. C. W.,
Twisk J. W. R.,
Hogenelst M. H. E.,
TrompWever A. M. E.,
Van Der Ploeg H. M.,
Heine R. J.
Publication year - 2008
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 - 10.1111/j.1464-5491.2008.02595.x
Subject(s) - medicine , randomized controlled trial , type 2 diabetes , depression (economics) , glycated hemoglobin , diabetes mellitus , distress , cognitive behavioral therapy , physical therapy , cognitive therapy , clinical psychology , endocrinology , economics , macroeconomics
Objective To test the effectiveness at 6 and 12 months’ follow‐up of group cognitive behavioural therapy (CBT) compared with blood glucose awareness training (BGAT) in poorly controlled Type 1 diabetic patients and to explore the moderating effect of baseline depression. Research design and methods Adults with Type 1 diabetes ( n = 86) with glycated haemoglobin (HbA 1c ) ≥ 8% were randomized to CBT or BGAT. Primary outcome was HbA 1c control. Secondary outcomes were: self‐care, diabetes‐related distress (Problem Areas in Diabetes scale; PAID), diabetes self‐efficacy (Confidence in Diabetes Self‐care scale; CIDS) and depressive symptoms (Centre for Epidemiological Studies – Depression scale; CES‐D). Measurements were scheduled before CBT and BGAT, and at 3, 6 and 12 months after. Differential effects were analysed for the subgroup of patients reporting low vs. high baseline levels of depression. Results Neither CBT nor BGAT had a significant impact on HbA 1c at 6 and 12 months’ follow‐up. Both interventions resulted in lower depressive symptoms (CES‐D 15.7–13.3, P = 0.01) up to 12 months, but only CBT was effective in lowering HbA 1c in patients with high baseline depression scores (HbA 1c 9.5–8.8%) up to 1 year of follow‐up ( P = 0.03). Conclusions Our findings suggest that group CBT can effectively help Type 1 diabetic patients with co‐morbid depression achieve and maintain better glycaemic outcomes.