The effectiveness of an emotion-focused educational programme in reducing diabetes distress in adults with type 2 diabetes mellitus at 12-month follow-up: a cluster randomized controlled trial
Boon-How Chew, Rimke C Vos, Aaron Fernandez, Sazlina Shariff Ghazali, Nurainul Hana Shamsuddin, Mastura Ismail, Guy E H M Rutten, Boon-How Chew, Rimke C Vos, Aaron Fernandez, Sazlina Shariff Ghazali, Nurainul Hana Shamsuddin, Mastura Ismail, Guy E H M Rutten
Abstract
Background: Diabetes distress (DD) is an increasingly important part of clinical medicine, diabetes self-management and research topic in people with diabetes mellitus. The present study evaluated the effectiveness of a value-based emotion-focused educational program in Malay adults with type 2 diabetes (VEMOFIT) at 12-month follow-up compared with a program with systematic attention to participants' emotions (attention-control).
Methods: VEMOFIT consisted of four biweekly group sessions and a booster session after 3 months; the attention-control program consisted of three sessions over the same period. Intention-to-treat analysis with multilevel mixed modelling was done to estimate the intervention effect.
Results: Participants (n = 124) randomized to VEMOFIT (n = 53) or attention-control (n = 71). Mean (SD) age 55.7 (9.7) years, median diabetes duration 7.0 (8.0) years and mean HbA1c level 9.7% (82 mmol/mol). The mean DD (DDS-17 scale) level decreased in both groups (from 3.4 to 3.3 versus 3.1-2.5, respectively), significantly more in the attention-control group [adjusted difference -0.6, 95% confidence interval (CI) -1.1, -0.2]. The VEMOFIT group had a significant improvement in self-efficacy (DMSES, range 0-200; adjusted difference 16.4, 99.4% CI 1.9, 30.9). Other outcomes did not differ.
Conclusions: Because the attention-control program resulted in a decreased DD 1 year later, its implementation on a larger scale seems justified.
Trial registration: NCT02730078; NMRR-15-1144-24803.
Keywords: behavioural medicine; depression; diabetes distress; educational models; emotions; type 2 diabetes mellitus.
Conflict of interest statement
Conflict of interest statement: The authors declare that there is no conflict of interest.
Figures
References
- American Diabetes Association. 5. Lifestyle management: standards of medical care in diabetes-2019. Diabetes Care 2019; 42(Suppl. 1): S46–S60.
- Perrin NE, Davies MJ, Robertson N, et al. The prevalence of diabetes-specific emotional distress in people with Type 2 diabetes: a systematic review and meta-analysis. Diabet Med 2017; 34: 1508–1520.
- Sturt J, Dennick K, Hessler D, et al. Effective interventions for reducing diabetes distress: systematic review and meta-analysis. International Diabetes Nursing 2015; 12: 40–55.
- Schmidt CB, van Loon BJP, Vergouwen ACM, et al. Systematic review and meta-analysis of psychological interventions in people with diabetes and elevated diabetes-distress. Diabet Med. Epub ahead of print 13 June 2018. DOI: 10.1111/dme.13709.
- Chew BH, Vos RC, Metzendorf MI, et al. Psychological interventions for diabetes-related distress in adults with type 2 diabetes mellitus (Review). Cochrane Database Syst Rev 2017; 9: CD011469.
- Winkley K, Al-Ozairi E, Chew BH. Chapter 17: cultural | global perspectives. In:Ismail K, Barthel A, Bornstein SR, et al.(eds) Depression and type 2 diabetes. Oxford, United Kingdom: Oxford University Press; 2018.
- Chew BH, Vos RC, Stellato RK, et al. The effectiveness of an emotion-focused educational programme in reducing diabetes distress in adults with Type 2 diabetes mellitus (VEMOFIT): a cluster randomized controlled trial. Diabet Med 2018; 35: 750–759.
- Wang RH, Hsu HC, Kao CC, et al. Associations of changes in psychosocial factors and their interactions with diabetes distress in patients with type 2 diabetes: a longitudinal study. J Adv Nurs 2017; 73: 1137–1146.
- Yi JP, Vitaliano PP, Smith RE, et al. The role of resilience on psychological adjustment and physical health in patients with diabetes. Br J Health Psychol 2008; 13: 311–325.
- Chew BH, Vos RC, Shariff Ghazali S, et al. The effectiveness of a value-based EMOtion-cognition-Focused educational programme to reduce diabetes-related distress in Malay adults with Type 2 diabetes (VEMOFIT): study protocol for a cluster randomised controlled trial. BMC Endocr Disord 2017; 17: 22.
- Chew BH, Fernandez A, Shariff-Ghazali S. Psychological interventions for behavioral adjustments in diabetes care - a value-based approach to disease control. Psychol Res Behav Manag 2018; 11: 145–155.
- Chew BH, Mukhtar F, Sherina MS, et al. The reliability and validity of the Malay version 17-item diabetes distress scale. Malays Fam Physician 2015; 10: 22–35.
- Ministry of Health Malaysia. Clinical practice guidelines: management of type 2 diabetes mellitus. 5th ed. Putrajaya, Malaysia: CPG Secretariat, Health Technology Assessment Section, Medical Development Division, 2015.
- Chew BH, Hassan NH, Sherina MS. Determinants of medication adherence among adults with type 2 diabetes mellitus in three Malaysian public health clinics: a cross-sectional study. Patient Prefer Adherence 2015; 9: 639–648.
- Low LL, Tong SF, Low WY. Selection of treatment strategies among patients with type 2 diabetes mellitus in Malaysia: a grounded theory approach. PLoS One 2016; 11: e0147127.
- Chew BH, Vos RC, Pouwer F, et al. The associations between diabetes distress and self-efficacy, medication adherence, self-care activities and disease control depend on the way diabetes distress is measured: comparing the DDS-17, DDS-2 and the PAID-5. Diabetes Res Clin Pract 2018; 42: 74–84.
- Okemah J, Peng J, Quinones M. Addressing clinical inertia in Type 2 diabetes mellitus: a review. Adv Ther 2018; 35: 1735–1745.
- Edelman SV, Polonsky WH. Type 2 diabetes in the real world: the elusive nature of glycemic control. Diabetes Care 2017; 40: 1425–1432.
Source: PubMed