Psychological Intervention for Type 1 Diabetes

Overseen By Haley Sandoval

Age: 18+

Sex: Any

Trial Phase: Phase 2

Sponsor: Scripps Whittier Diabetes Institute

Disqualifiers: Severe medical, psychological conditions, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Prior Safety Data This treatment has passed at least one previous human trial

Approved in 1 Jurisdiction This treatment is already approved in other countries

Compensation: Varies

Number of Visits: 5

Duration: 5 sessions over 6 months

250 Participants Needed

Trial Summary

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications.

What data supports the effectiveness of the treatment ACT1VATE for improving outcomes among adults with Type 1 diabetes?

Research shows that targeted psychological interventions can reduce diabetes distress, which is linked to better diabetes management and improved blood sugar control in adults with Type 1 diabetes. ^{1 2 3 4 5}

Is the psychological intervention for Type 1 Diabetes safe for humans?

The research does not provide specific safety information about the psychological intervention, but it focuses on reducing diabetes distress, which is generally considered safe as it involves addressing emotional and mental health. ^{1 2 3 4 5}

How is the ACT1VATE treatment different from other treatments for type 1 diabetes?

ACT1VATE is unique because it focuses on reducing emotional distress related to managing type 1 diabetes, which can lead to better blood sugar control and overall health. Unlike traditional treatments that primarily target blood sugar levels directly, this approach addresses the emotional challenges of living with diabetes. ^{2 3 5 6 7}

What is the purpose of this trial?

This research will compare a psychological intervention ("ACT1VATE") versus diabetes self-management education and support (DSME/S; usual care) in improving clinical, behavioral, psychosocial, process, and cost outcomes among adults with poorly controlled type 1 diabetes (T1D) who are experiencing significant diabetes-related emotional distress and poor glycemic control in a real world, healthcare environment.

Research Team

Athena Philis-Tsimikas, MD

Principal Investigator

Scripps Whittier Diabetes Institute

Addie Fortmann, PhD

Principal Investigator

Scripps Whittier Diabetes Institute

Eligibility Criteria

This trial is for adults with Type 1 Diabetes who feel very stressed about their diabetes and have high blood sugar levels (HbA1c ≥ 8% in the last 90 days). They must speak English or Spanish, be a patient at Scripps Health, and plan to stay in San Diego for the next year. People with severe health or mental issues that could affect participation are not eligible.

Inclusion Criteria

I have been diagnosed with Type 1 diabetes.

Glycosylated Hemoglobin (HbA1c) between 7.5% and 12.5% in the last 90 days

Screen positive for diabetes distress

Exclusion Criteria

Severe medical or psychological conditions that would interfere with participation based on the opinion of a provider

Plans to move out of the San Diego area in the next 12 months

Lack of technology capability required to complete online surveys and telemedicine visit

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants receive either the ACT1VATE psychological intervention or DSME/S usual care via telemedicine

5 sessions over 6 months

5 group-therapy sessions (virtual) for ACT1VATE group

Follow-up

Participants are monitored for changes in glycemic control and emotional distress

12 months

Quarterly standard-of-care medical visits

Process Evaluation

Evaluation of reach, acceptability, feasibility, adoption, maintenance, and fidelity of the intervention

12 months

Treatment Details

Interventions

• ACT1VATE
• DSME/S

Trial Overview The study compares 'ACT1VATE', a psychological intervention aimed at reducing stress related to diabetes, against standard diabetes education and support (DSME/S) to see which is better at improving control of blood sugar levels and overall well-being among patients.

Participant Groups

Group I: ACT1VATE Experimental Treatment 1 Intervention

Participants assigned to the intervention group will be offered a psychological intervention specifically designed to address diabetes-related emotional distress.

Group II: DSME/S (usual care) Active Control 1 Intervention

Participants randomized to the usual care group will be offered standard diabetes self-management education and support (DSME/S).

Who Is Running the Clinical Trial?

Scripps Whittier Diabetes Institute

Lead Sponsor

Trials

19

Recruited

5,400+

National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)

Collaborator

Trials

2,513

Recruited

4,366,000+

Findings from Research

Targeted interventions significantly reduced diabetes distress in adults with Type 1 diabetes, with an average decrease of 0.6 points in the intervention group compared to only 0.2 points in the untreated group, indicating the efficacy of the intervention.

Without treatment, over half (51%) of individuals with elevated diabetes distress continued to experience high levels of distress after 9 months, highlighting that untreated diabetes distress tends to remain chronic.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

There is value in treating elevated levels of diabetes distress: the clinical impact of targeted interventions in adults with Type 1 diabetes. Hessler, D., Fisher, L., Polonsky, W., et al.[2022]

The Type 1 Diabetes Distress Scale (T1-DDS) was validated in a large sample of 2201 adults with Type 1 diabetes in Denmark, showing good content and construct validity for assessing diabetes-related distress.

The T1-DDS demonstrated a strong correlation with the Problem Areas In Diabetes scale (PAID-20) and good reliability in retest scores, but the study also revealed that it does not encompass all potential stressors faced by individuals with Type 1 diabetes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Validation of the type 1 diabetes distress scale (T1-DDS) in a large Danish cohort: Content validation and psychometric properties. Joensen, LE., Lindgreen, P., Olesen, K., et al.[2023]

Both the OnTrack (emotion-focused) and KnowIt (educational/behavioral) interventions significantly reduced diabetes distress (DD) among 301 adults with type 1 diabetes, with an effect size indicating a strong impact, but no significant differences in effectiveness between the two methods.

While both interventions led to modest improvements in glycemic control (HbA1c), the reduction in DD was only weakly associated with changes in HbA1c, suggesting that addressing emotional and cognitive factors is crucial for effective diabetes management.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

T1-REDEEM: A Randomized Controlled Trial to Reduce Diabetes Distress Among Adults With Type 1 Diabetes. Fisher, L., Hessler, D., Polonsky, WH., et al.[2022]

Psychological interventions, such as counseling and cognitive behavior therapy, significantly reduced glycated hemoglobin levels in children and adolescents with type 1 diabetes, indicating improved glycaemic control.

In contrast, these psychological therapies did not show a significant effect on glycaemic control in adults with type 1 diabetes, although they did help reduce psychological distress in younger patients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Psychological interventions to improve glycaemic control in patients with type 1 diabetes: systematic review and meta-analysis of randomised controlled trials. Winkley, K., Ismail, K., Landau, S., et al.[2022]

In a study involving 301 adults with type 1 diabetes, reductions in diabetes distress were linked to improved self-care behaviors, such as better insulin management and increased blood glucose monitoring, which are crucial for effective diabetes management.

The improvements in self-care behaviors subsequently led to better glycemic outcomes, including lower HbA1c levels and fewer hypoglycemic episodes, highlighting the importance of addressing diabetes distress to enhance overall diabetes care.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Reductions in Management Distress Following a Randomized Distress Intervention Are Associated With Improved Diabetes Behavioral and Glycemic Outcomes Over Time. Hessler, D., Strycker, L., Fisher, L.[2022]

A study involving 305 U.S. adults with type 1 diabetes identified seven key sources of diabetes distress, including Powerlessness and Hypoglycemia Distress, which were confirmed in a separate sample of 109 Canadian participants.

The prevalence of diabetes distress was notably high, with 41.6% of participants experiencing at least moderate distress, particularly among women, younger individuals, and those with poor glycemic control, highlighting the need for targeted support in clinical care.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Understanding the sources of diabetes distress in adults with type 1 diabetes. Fisher, L., Polonsky, WH., Hessler, DM., et al.[2022]

The FEEL-T1D study is investigating the relationships between blood glucose levels, emotional well-being, and functional ability in 200 adults with type 1 diabetes, using remote data collection methods including continuous glucose monitoring and ecological momentary assessments.

As of June 2021, the study has successfully enrolled 124 participants and achieved high completion rates for data collection, indicating that the remote study design has been effective, especially during the COVID-19 pandemic.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Function and Emotion in Everyday Life With Type 1 Diabetes (FEEL-T1D): Protocol for a Fully Remote Intensive Longitudinal Study. Pyatak, EA., Hernandez, R., Pham, LT., et al.[2023]

References

1. England pubmed.ncbi.nlm.nih.gov

There is value in treating elevated levels of diabetes distress: the clinical impact of targeted interventions in adults with Type 1 diabetes. [2022]

2. England pubmed.ncbi.nlm.nih.gov

Validation of the type 1 diabetes distress scale (T1-DDS) in a large Danish cohort: Content validation and psychometric properties. [2023]

3. United States pubmed.ncbi.nlm.nih.gov

T1-REDEEM: A Randomized Controlled Trial to Reduce Diabetes Distress Among Adults With Type 1 Diabetes. [2022]

4. England pubmed.ncbi.nlm.nih.gov

Psychological interventions to improve glycaemic control in patients with type 1 diabetes: systematic review and meta-analysis of randomised controlled trials. [2022]

5. United States pubmed.ncbi.nlm.nih.gov

Reductions in Management Distress Following a Randomized Distress Intervention Are Associated With Improved Diabetes Behavioral and Glycemic Outcomes Over Time. [2022]

6. United States pubmed.ncbi.nlm.nih.gov

Understanding the sources of diabetes distress in adults with type 1 diabetes. [2022]

7. Canada pubmed.ncbi.nlm.nih.gov

Function and Emotion in Everyday Life With Type 1 Diabetes (FEEL-T1D): Protocol for a Fully Remote Intensive Longitudinal Study. [2023]