OBJECTIVE This study evaluated the effect of cognitive behavioral therapy (CBT) plus lifestyle counseling in primary care on hemoglobin A1c (HbA1c) in rural adult patients with type 2 diabetes (T2D) and comorbid depressive or regimen-related distress (RRD) symptoms. RESEARCH DESIGN AND METHODS This study was a randomized controlled trial of a 16-session severity-tailored CBT plus lifestyle counseling intervention compared with usual care. Outcomes included changes in HbA1c, RRD, depressive symptoms, self-care behaviors, and medication adherence across 12 months. RESULTS Patients included 139 diverse, rural adults (mean age 52.6 6 9.5 years; 72% black; BMI 37.0 6 9.0 kg/m2) with T2D (mean HbA1c 9.6% [81 mmol/mol] 6 2.0%) and comorbid depressive or distress symptoms. Using intent-to-treat analyses, patients in the intervention experienced marginally significant improvements in HbA1c (20.92 6 1.81 vs. 20.31 6 2.04; P = 0.06) compared with usual care. However, intervention patients experienced significantly greater improvements in RRD (21.12 6 1.05 vs. 20.31 6 1.22; P = 0.001), depressive symptoms (23.39 6 5.00 vs. 20.90 6 6.17; P = 0.01), self-care behaviors (1.10 6 1.30 vs. 0.58 6 1.45; P = 0.03), and medication adherence (1.00 6 2.0 vs. 0.17 6 1.0; P = 0.02) versus usual care. Improvement in HbA1c correlated with improvement in RRD (r = 0.3; P = 0.0001) and adherence (r = 20.23; P = 0.007). CONCLUSIONS Tailored CBT with lifestyle counseling improves behavioral outcomes and may improve HbA1c in rural patients with T2D and comorbid depressive and/or RRD symptoms.
CITATION STYLE
Cummings, D. M., Lutes, L. D., Littlewood, K., Solar, C., Carraway, M., Kirian, K., … Hambidge, B. (2019). Randomized trial of a tailored cognitive behavioral intervention in type 2 diabetes with comorbid depressive and/or regimen-related distress symptoms: 12-month outcomes from. In Diabetes Care (Vol. 42, pp. 841–848). American Diabetes Association Inc. https://doi.org/10.2337/dc18-1841
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