We found a match
Your institution may have rights to this item. Sign in to continue.
- Title
A Diabetes and Psychological Treatments Study (ADAPT): Results from a Randomised Controlled Trial.
- Authors
Ismail, Khalida; Maissi, Esther; Treasure, Janet; Chalder, Trudie; Thomas, Stephen; Dickens, Christopher; Creed, Francis; Bartlett, Jonathan; Patel, Anita
- Abstract
Despite intensive medical regimes, suboptimal glycaemic control is common in people with type 1 diabetes. The pooled evidence that psychological treatments are effective in improving glycaemic control is limited. We conducted a multicenter randomised controlled trial comparing two psychological interventions with usual care for adults with type 1 diabetes to improve glycaemic control. Six nurses were trained to deliver diabetes specific motivational enhancement therapy (MET) and cognitive behaviour therapy (CBT) using a standardised manualised training and competency ratings. Trial criteria were adults (18-65 years) with type 1 diabetes (duration ≥ 2 years); local residents of the 9 study hospitals in London and Manchester, United Kingdom; no advanced diabetes complications or severe mental illness; not pregnant or planning pregnancy; at least one A1c in past 12 months plus current A1c ≥ 8.2 and ≤ 15.0%. After baseline assessments, participants were randomised to either 4 sessions of MET followed by 8 sessions of CBT over 6 months or 4 sessions of MET over 2 months or usual diabetes care using computerised proportional minimised randomised blocks and allocation concealment. The main outcome was A1c 12 months from baseline (technicians blind to allocation) adjusted for baseline A1c. Using clinic registers, 2323 adults with type 1 diabetes were screened, of which 1232 did not meet trial criteria, 412 had incomplete assessments, 291 refused, 44 were untraceable and 344 were randomised. GHb was collected in 91.2% (n=316) for the 12 months followup. The sample characteristics were: median age 36 years (interquartile range (IQR) 28-44); duration of diabetes 18 years (IQR 11-25); Ale was 9.4% (IQR 8.8-10.2); 61% female; 80% white; 18% had a depressive disorder. The nurses were competent in MET (Motivational Interviewing Treatment Integrity scale mean empathy score 5.2) and CBT (Cognitive Therapy Rating Scale-Revised mean score 52.4. The adjusted mean 12 month A1c was 0.4% (95% confidence interval (CI) 0.1 to 0.8) lower in the MET+CBT group than in the usual care group which was statistically significant. The adjusted mean 12 month Ale was 0.1% (95% CI -0.2 to 0.5) lower in the MET group than the usual care group but this was not statistically significant. Nurse delivered MET followed by CBT resulted in a clinically significant improvement in glycaemic control.
- Subjects
ENGLAND; TREATMENT of diabetes; MOTIVATIONAL interviewing; BEHAVIOR therapy; GLYCEMIC index
- Publication
Diabetes, 2007, Vol 56, pA43
- ISSN
0012-1797
- Publication type
Article