Emotion-Centered Virtual Program Cuts Diabetes Distress in Half, Improves Glucose Control

A study led by researchers at UC San Francisco has found that focusing on managing the emotional strain of Type 1 diabetes significantly reduces distress and improves glucose control, highlighting the role of mental health in diabetes management.

According to the study, published in Diabetes Care, diabetes distress involves the emotional burdens, fears, and worries associated with managing diabetes. Researchers said that it affects up to 75 percent of adults with type 1 diabetes and is linked to poor self-management, such as missing medication doses, elevated glucose levels, and lower quality of life.

For this study, researchers sought to explore ways to decrease diabetes distress and improve glucose control in people with type 1 diabetes. The investigation included 276 adults with type 1 diabetes and elevated diabetes distress who were randomly assigned to one of three programs, including:

• Education-focused program: Concentrated on diabetes education and management.
• Emotion-focused program (TunedIn): Concentrated on the emotional aspects of living with diabetes.
• Combination program: Merged elements of both education and emotional support.

The results showed that all three programs led to significant reductions in diabetes distress and improvements in hemoglobin A1C levels. However, TunedIn showed the most consistent benefits. Half of its participants no longer experienced diabetes distress after one year, compared to 27 percent in the education-focused group and 31 percent in the combination group. Additionally, 56 percent of TunedIn participants achieved a clinically significant A1C reduction of 0.5 percent or more.

The authors explained that TunedIn incorporates strategies from Acceptance and Commitment Therapy (ACT), which helps individuals recognize how painful emotions and beliefs influence behavior. ACT has proven effective across various chronic diseases and stress-related conditions.

The study's findings have led the UCSF Diabetes Center to integrate diabetes distress screening into routine practice. “If you don't address the emotional part of living with the illness, you don’t do well,” said co-author Umesh Masharani, MBBS, a UCSF professor of endocrinology. “It’s important that clinicians are trained on how to have these conversations with their patients with diabetes as part of normal care.”

The study concluded that virtual programs like TuneIn could help a broad range of people with type 1 diabetes improve their mental health and glucose control, including those who don’t have access to a clinician.

"Most patients with diabetes have never heard of diabetes distress or been asked about it, and don't understand that it can be alleviated," said first author Danielle Hessler Jones, PhD, professor and vice chair for research in the UCSF Department of Faculty and Community Medicine. "Knowing virtual group-based programs are effective presents an opportunity to change that.”