medwireNews: Cognitive behavioural therapy (CBT) may be a more effective intervention than non-directive, supportive counselling for adolescents with type 1 diabetes who struggle with glycaemic control, a randomised control trial shows.
The researchers found that glycated haemoglobin (HbA1c) levels remained stable in patients given CBT, whereas they deteriorated over time in those given an equivalent amount of supportive counselling, “mirroring the pattern observed in clinical practice and population-based studies.”
The study participants were aged between 11 and 16 years and had HbA1c levels ranging from 6.2% to 14.2%. They undertook six weekly sessions of CBT or counselling, with an additional session at 6 months and then one at 12 months.
After a further year of follow-up, the geometric mean HbA1c in the 33 patients randomly assigned to the CBT group was 8.9%, which was not significantly different to the baseline level of 8.7%. By contrast, levels in the 33 patients assigned to counselling deteriorated significantly from 8.4% to 9.4%.
Elizabeth Crowne (University Hospitals Bristol, UK) and co-researchers stress that, although improvement in metabolic control is known to delay the onset or slow the progression of diabetic complications, maintaining HbA1c at a stable level “is a clinically significant result in itself”, warranting further study of CBT.
In addition, the team found a significant improvement in HbA1c levels only among patients in the CBT group who were in the lowest tertile for depressive symptoms, from 8.6% to 8.3%, in line with previous findings that CBT may be less effective in patients with more significant depression.
Notably, depressive symptoms improved in the counselling group. The researchers say this could simply be because of their higher scores at baseline, but could also reflect the supportive nature of the intervention, which “exerts less pressure and expectations on the patients” than CBT does.
“In clinical practice, full formal courses of CBT or other psychological interventions are labour intensive with poor uptake in patients who are not motivated”, the team writes in Pediatric Diabetes.
“However, it is possible to implement basic techniques of CBT in patients during their routine care by other health professionals in the diabetes multidisciplinary team such as nurses who have undergone recognised training.”
But they suggest that non-directive counselling could be a more appropriate first-line therapy in patients with notable depressive symptoms.
By Eleanor McDermid
Pediatr Diabetes 2017; Advance online publication
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