Three interventions in 300 adults with type 1 diabetes
Meanwhile, EMBARK recruited 300 patients with type 1 diabetes in the United States from clinics and community organizations who were aged 21 and older and had an elevated type 1 diabetes distress score (> 2.0) and A1c greater than or equal to 7.5%.
Participants were a mean age of 46 years, 79% were female, and 89% were White. They had a type 1 diabetes distress score of 2.8, a mean A1c of 8.3%, and 71% used an insulin pump and 79% used a continuous glucose monitor.
Participants were randomized to one of three interventions:
- Streamline: A traditional diabetes educator-led education and management program.
- Tuned-in: A psychologist-led program focused exclusively on reducing diabetes distress.
- Fixit: An integration of the two programs.
Interventions were given virtually over 3 months to small groups of 8-12 individuals and included initial workshops, one-to-one phone calls, and follow-up group meetings. Participants were then followed for 8 months.
Researchers found statistically significant and substantial reductions in overall diabetes distress in all three interventions, with the greatest reductions in the combined intervention group, which were greater than in the educational approach alone group (P = .005).
The percentage of participants who no longer reported elevated diabetes distress at follow-up was 25% in Streamline, 37% in Tuned-in, and 42% in Fixit.
The percentage of participants who reported a minimal clinically important difference – the smallest change in a treatment outcome that an individual would identify as important – was also greatest in those in the Fixit intervention group (82%) than in the Tuned-in (74%) or Streamline (65%) interventions.
‘Adding the psychologist is where the real magic happens’
“The certified diabetes care specialist intervention is really a very standard thing that most clinicians would have access to; they tend to focus on knowledge and problem solving and some of the psychosocial issues,” Robert Gabbay, MD, PhD, chief scientific and medical officer for the ADA, said in an interview.
The EMBARK trial found a “graded response: CDCS alone, psychologist really focused on diabetes distress, and the two together, which would be the ideal practice model,” he noted.
There are these validated ways of measuring diabetes distress using a diabetes distress survey tool, which is also underutilized.
“Adding the psychologist is really where the real magic happens in terms of diabetes distress,” Dr. Gabbay said.
“As you can imagine, [if] somebody ... feels powerless, it is going to be tough to manage their diabetes and unlikely to be terribly successful,” he observed. Often, these individuals are just not doing well. This study highlighted the importance of identifying this.
“I’m encouraged by the findings from the studies presented during this year’s Scientific Sessions as we continue to seek out innovative, evidence-based solutions that support people living with diabetes when they need it the most,” Dr. Gabbay concluded.
A version of this article originally appeared on Medscape.com.