For type 1 diabetes problems, researchers say to focus on managing emotions first

The most effective way to reduce the suffering associated with having diabetes – and improve glucose control – is to focus on managing the emotional strain of living with the condition, according to a study new study among adults, led by researchers at UC San Francisco.

Diabetes distress, or DD, refers to the fears, worries, and burdens associated with living with and managing diabetes, and affects up to 75% of adults with type 1 diabetes. It is related to poor self-management, such as missing medication doses, elevated glucose levels, more cases of low blood glucose (hypoglycemia), and lower quality of life.

The recent one studypublished in Diabetes Care, compared three group programs, all of which were delivered virtually. The first focused on diabetes education and treatment, the second on the emotional side of living with diabetes, and the third combined the two approaches.

All three programs produced significant and clinically meaningful reductions in diabetes problems and hemoglobin A1C, which measures glucose control. But the emotion-focused program, called TunedIn, showed the most consistent benefits and was far more effective at lowering DD than any other intervention studied.

“Most patients with diabetes have never heard of or been asked about diabetes problems and do not understand that it can be alleviated,” said first author Danielle Hessler Jones, Ph.D., professor and vice chair for research at UCSF Department Faculty and Community Medicine. “Knowing that virtual group-based programs are effective provides an opportunity to change that.”

Improving access to care

Two hundred and seventy-six adults with type 1 diabetes and increased diabetes problems took part in the study, which was conducted between 2019 and 2022. Participants were randomly assigned to one of three programs, each of which included a series of virtual meetings over a period of three to four months, including group workshops, group discussions and a one-on-one conversation with the instructor.

Half of the study participants no longer had diabetes problems after one year of using TunedIn, compared to 27% of those who used the education-oriented program and 31% of those who used the combination program. TunedIn also had the highest percentage of participants (56%) whose A1C dropped by 0.5% or more, which is clinically and statistically significant.

TunedIn incorporates elements and strategies of Acceptance and Commitment Therapy (ACT), which increase awareness of how painful emotions and beliefs can drive behavior that conflicts with diabetes management. Previous research has shown that ACT strategies have proven effective in a range of chronic diseases and other stress-related environments.

“Giving people with type 1 diabetes the opportunity to recognize, observe, and ‘be alongside’ these processes can help them make different choices, choices that can have a positive impact on their health and well-being,” Jones said.

Based on this research, the UCSF Diabetes Center has begun integrating screening for diabetes problems into its practice.

“If you’re not addressing the emotional part of living with the disease, you’re not doing it right,” says co-author Umesh Masharani, MBBS, a UCSF professor of endocrinology. “It is important that physicians are trained to have these conversations with their patients with diabetes as part of normal care.”

TunedIn could broaden access for patients across the country, and potentially globally, who cannot book treatment with clinical experts in diabetes, Jones added. The research team’s work has received international attention under the leadership of co-author Lawrence Fisher, Ph.D., ABPP, professor emeritus at UCSF and director of the Behavioral Diabetes Research Group. Fisher is currently working with colleagues to implement DD programs in the UK and Europe.

“Because there are so few mental health specialists and psychologists trained in diabetes, virtual programs are really needed to provide this type of evidence-based treatment to patients who cannot come to us,” Jones said.