Psychotherapy may help with diabetes control

NEW YORK (Reuters Health) - Integrating motivational enhancement therapy with cognitive behavioral therapy may help people with type 1 diabetes better manage their disease, British researchers report.

People with type I diabetes must inject insulin, monitor their diet, and exercise to control their blood sugar levels. Psychological issues may interfere with diabetes management. The effectiveness of psychological treatments in improving diabetes outcomes is uncertain.

To investigate, Dr. Khalida Ismail from King's College London and colleagues assigned 344 type 1 diabetic patients with poorly controlled diabetes to either regular care, cognitive behavioral therapy (therapy that focuses on identifying and changing negative behaviors), or a combination of nurse-delivered cognitive behavioral therapy and motivational enhancement therapy (brief counseling that focuses on self-motivation).

Over 12 months, the researchers collected information on change in blood sugar levels, low blood sugar episodes, depression, quality of life, diabetes self-care activities, and weight.

They found that patients who received both psychological therapies fared the best, having a greater decrease in blood sugar levels than patients who received usual care. However, the changes were small, they say, and this study cannot determine whether they would persist beyond 12 months.

Nonetheless, the researchers conclude that the change was clinically meaningful, citing the Diabetes Control and Complications Trial, in which any decrease blood sugar levels was associated with a decrease in the development of diabetes complications.

SOURCE: Annals of Internal Medicine, November 18, 2008.