Cognitive behavioural therapy stabilises glycaemic control in adolescents with type 1 diabetes-Outcomes from a randomised control trial

Christina Wei, Ruth J. Allen, Patricia M. Tallis, Fiona J. Ryan, Linda P. Hunt, Julian P.H. Shield, Elizabeth C. Crowne*

*Corresponding author for this work

Research output: Contribution to journalArticle (Academic Journal)

5 Citations (Scopus)
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Abstract

Background: To compare the impact of cognitive behavioural therapy (CBT) with non-directive supportive counselling (NDC) on glycaemic control and psychological well-being in adolescents with type 1 diabetes mellitus (T1DM). Materials and Methods: Participants aged 11 to 16years with T1DM (duration ≥1year) from 4 UK-based paediatric diabetes centres were randomised to receive either 6 weekly sessions of 1-to-1 CBT (n=43) or NDC (n=42), with 2 further sessions at 6 and 12months. Follow-up continued for 12months postintervention. Outcome measures included glycated haemoglobin A1c (HbA1c) and psychological scores. Results: The HbA1c levels were available in 33 patients in each group for analysis. Between group difference of the overall changes in HbA1c across the study period was statically significant (P=.018). Geometric mean (range) HbA1c in the NDC group deteriorated from 68 (46-113) to 78 (48-128)mmol/mol (ie, 8.4 [6.4-12.5]% to 9.3 [6.5-13.9]%; P=.001), but was maintained in the CBT group from 72 (46-129) to 73 (51-128) mmol/mol (P=.51) (ie, 8.7 [6.4-14]% to 8.9 [6.8-13.9]%). More patients who have undergone CBT showed an improved or maintained HbA1c levels at 24months (62.5% vs 35.5%, P=.032). Patients offered CBT with depressive scores in the lowest tertile (least depressive symptoms) showed improvement in HbA1c over time from 70 (46-102) to 67 (57-87) mmol/mol (P=.041) (ie, 8.6 [6.4-11.5]% to 8.3 [7.4-10.1]%), but not in the NDC group. The CBT showed borderline improvements in Children's Health Locus of Control (internal) scores over time compared with NDC (P=.05). The self-efficacy score showed significant improvement in both CBT (P<.001) and NDC (P=.03) groups over time. Conclusions: CBT demonstrated better maintenance of glycaemic control compared with NDC.

Original languageEnglish
JournalPediatric Diabetes
Early online date17 Apr 2017
DOIs
Publication statusE-pub ahead of print - 17 Apr 2017

Keywords

  • Adolescents
  • Cognitive behavioural therapy
  • Glycaemic control
  • Psychological therapy
  • Type 1 diabetes

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