Abstract
Objectives: In a randomized controlled trial, adults with Type 1 diabetes and suboptimal glycemic control who received motivational enhancement therapy (MET) plus cognitive behavioral therapy (CBT) had a greater reduction in their 12-month hemoglobin A1c (HbA1c) than those who received usual care (UC). We tested whether improvements in glycemic control persisted up to 4 years after randomization.
Methods: In the original trial, participants were randomized to UC (n = 121), 4 sessions of MET (n = 117), or 4 sessions of MET plus 8 sessions of CBT (n = 106). Of the 344 patients who participated in the original trial, 260 (75.6%) consented to take part in this posttrial study. A linear mixed model was fitted to available measurements to assess whether intervention effects on HbA1c at 12 months were sustained at 2, 3, and 4 years.
Results: Estimated mean HbA1c level was lower for participants in the two intervention arms when compared with UC at 2, 3, and 4 years, but none of the differences were statistically significant. At 4 years, estimated mean HbA1c level for MET plus CBT was 0.28% (95% confidence interval = −0.22% to 0.77%) lower than that for UC, and estimated mean HbA1c level for MET was 0.17% (95% confidence interval = −0.33% to 0.66%) lower than that for UC.
Conclusions: There was no evidence of benefit for patients randomized to MET plus CBT at 2, 3, or 4 years. Larger studies are needed to estimate long-term treatment effects with greater precision. Current models of psychological treatments in diabetes may need to be intensified or include maintenance sessions to maintain improvements in glycemic control.
Methods: In the original trial, participants were randomized to UC (n = 121), 4 sessions of MET (n = 117), or 4 sessions of MET plus 8 sessions of CBT (n = 106). Of the 344 patients who participated in the original trial, 260 (75.6%) consented to take part in this posttrial study. A linear mixed model was fitted to available measurements to assess whether intervention effects on HbA1c at 12 months were sustained at 2, 3, and 4 years.
Results: Estimated mean HbA1c level was lower for participants in the two intervention arms when compared with UC at 2, 3, and 4 years, but none of the differences were statistically significant. At 4 years, estimated mean HbA1c level for MET plus CBT was 0.28% (95% confidence interval = −0.22% to 0.77%) lower than that for UC, and estimated mean HbA1c level for MET was 0.17% (95% confidence interval = −0.33% to 0.66%) lower than that for UC.
Conclusions: There was no evidence of benefit for patients randomized to MET plus CBT at 2, 3, or 4 years. Larger studies are needed to estimate long-term treatment effects with greater precision. Current models of psychological treatments in diabetes may need to be intensified or include maintenance sessions to maintain improvements in glycemic control.
| Original language | English |
|---|---|
| Pages (from-to) | 319-323 |
| Number of pages | 5 |
| Journal | Psychosomatic Medicine |
| Volume | 74 |
| Issue number | 3 |
| DOIs | |
| Publication status | Published - Apr 2012 |
Keywords
- MANAGEMENT
- randomized controlled trial
- type 1 diabetes
- DEPRESSION
- SIMULATION
- COGNITIVE-BEHAVIOR THERAPY
- INTERVENTION
- COMPLICATIONS
- METAANALYSIS
- long-term follow-up
- suboptimal glycemic control
- PREVALENCE
- DISORDERS
