To Treat High Diabetes Distress Or Not: Determining The Clinical Impact Of Targeted Interventions With Type 1 Adults

A recent study (T1-REDEEM) reported the relative effectiveness of two interventions to reduce high diabetes distress (DD) among adults with type 1 diabetes (T1). While these results show promise regarding the efficacy of DD-targeted interventions, there is little evidence to support their use when compared to non-treatment controls. We leveraged two recent studies to examine differences between the effect of targeted interventions on high DD T1 adults and a comparable sample of untreated participants, as well as to document the stability of untreated DD over time. T1 adults with elevated baseline DD (mean ≥ 2.0) and HbA1c (≥ 7.5), identified from a longitudinal, non-intervention, observational study (non-INT) (N = 51, age = 40.4 [SD = 16.8], 72.5% female, baseline DD = 2.5 [SD = 0.4], baseline HbA1c = 8.4 [SD = 1.3]), were compared to a matched sample of T1 adults who participated in T1-REDEEM (INT) (N=51, age = 48.8 [SD = 15.3], 74.5% female, baseline DD = 2.6 [SD = 0.4], baseline HbA1c = 8.7 [SD = 1.0]). Both groups completed the T1-DDS questionnaire at baseline and 9 months. Large reductions in DD (mean ∆ ± SD) were reported in the INT group (-0.6 ± 0.6), while minimal change was reported in the non-INT group (-0.2 ± 0.6), yielding a statistically and clinically meaningful difference (-0.4±0.6, p = 0.002; effect size d=.67) between groups. Additional analyses using the established MCID (0.19) for the T1-DDS showed that DD increased significantly (≥ 1 MCID) or persisted at high levels for 51% of non-INT participants, compared to 23.5% in the INT group. Targeted interventions lead to dramatic reductions in DD when compared to untreated individuals. Furthermore, high DD does not resolve over time when left unaddressed; in fact, DD remains high or worsens in more than half of non-INT participants. These data suggest that interventions targeting DD are clinically effective in T1 adults with high DD relative to non-treatment controls, and that high DD can become chronic if left untreated. Disclosure J. Parra: Employee; Self; Behavioral Diabetes Institute. D.M. Hessler: Consultant; Self; Eli Lilly and Company. L. Fisher: Consultant; Self; Abbott, Eli Lilly and Company. W. Polonsky: Consultant; Self; Abbott, Bigfoot Biomedical, Dexcom, Inc., Eli Lilly and Company, Insulet Corporation, Johnson u0026 Johnson Diabetes Institute, Merck u0026 Co., Inc., Novo Nordisk Inc., Sanofi, Servier. L.A. Strycker: None. V. Bowyer: None. M. Dedhia: None. U. Masharani: Research Support; Self; Clementia Pharmaceuticals. Funding National Institutes of Health