, according to two new studies in patients with type 1 diabetes presented at the annual scientific sessions of the American Diabetes Association.
Danielle Hessler Jones, PhD, presented findings from Behavioral Approaches to Reducing Diabetes Distress and Improving Glycemic Control (EMBARK) in adults with type 1 diabetes during an oral session.
The three-arm randomized trial found that patients had the greatest improvements in feelings of powerlessness after a 3-month behavioral intervention that combined type 1 diabetes education plus specific attention to diabetes distress.
And in a late-breaking poster, “Do The Right Thing: Behavioral Intervention for At-Risk T1D Youth,” David V. Wagner, PhD, showed that a behavioral intervention not only improved glycemic management but also reduced cost of care in disadvantaged youth.
“Diabetes distress is the emotional response to living with diabetes, the burden of relentless daily self-management, and the prospect of its long-term complications,” said Dr. Hessler Jones, professor and vice chair for research in the department of family and community medicine at the University of California, San Francisco.
It is common, experienced by 20%-58% of people with type 1 and type 2 diabetes, and is different from depression, as it is associated with glycemic control and disease management. It “is also chronic and does not disappear on its own without intervention,” she stressed.
“It is the expected worries, concerns, and fears that are associated with struggling with a demanding and progressive chronic disease and its management,” she added.
The findings from EMBARK “suggest that distress reductions are greatest when interventions integrate education alongside approaches to address the emotional side of diabetes,” she said.
The group is also analyzing changes in A1c with the three different interventions in EMBARK, with results expected this fall.
Dr. Hessler Jones said they also just received funding for DDASSIST, which will answer the question: “How do I translate this into care in my clinic?” The aim of the clinic training program is to bring the intervention to the diabetes care team.
“Could this program be delivered by somebody else, other than a psychologist?” an audience member asked. They will be looking at this, she replied.
‘Do the right thing’
For the late-breaking poster by Dr. Wagner and colleagues, researchers evaluated direct cost data from three health care systems provided for youth with type 1 diabetes who received an intensive behavioral health intervention, Novel Interventions in Children’s Healthcare (NICH).
Youths were included in the analyses if they had type 1 diabetes and at least 1 year of cost data prior to and following NICH enrollment. Outpatient, emergency department, and inpatient costs were combined. The analysis included 53 youth with the following characteristics: mean age, 14.2 years; 87% Medicaid; 58% female; 32% Black, 29% Non-Hispanic White, 28% Hispanic/Latinx, 7% Pacific Islander, 2% Asian, and 2% other racial and ethnic groups.
Average yearly costs significantly decreased from $20,400 per youth prior to NICH to $9,500 per youth afterward, largely due to inpatient charges.
“These results highlight the benefits of providing access to intensive interventions to pediatric populations experiencing health disparities,” said Dr. Wagner. “Investing early in the lives of youth experiencing health disparities is not only the right thing to do to improve patients’ health but it could also have a positive economic impact down the road.”