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Original Research

REDEEM: A Pragmatic Trial to Reduce Diabetes Distress

  1. Lawrence Fisher, PHD, ABPP1⇑,
  2. Danielle Hessler, PHD1,
  3. Russell E. Glasgow, PHD2,
  4. Patricia A. Arean, PHD1,
  5. Umesh Masharani, MD1,
  6. Diana Naranjo, PHD1 and
  7. Lisa A. Strycker, MA3
  1. 1University of California, San Francisco, San Francisco, California
  2. 2Implementation Science, Division of Cancer Control and Population Science, National Cancer Institute, Rockville, Maryland
  3. 3Oregon Research Institute, Eugene, Oregon
  1. Corresponding author: Lawrence Fisher, fisherl{at}fcm.ucsf.edu.
Diabetes Care 2013 Sep; 36(9): 2551-2558. https://doi.org/10.2337/dc12-2493
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Abstract

OBJECTIVE To compare three interventions to reduce diabetes distress (DD) and improve self-management among non–clinically depressed adults with type 2 diabetes mellitus (T2DM).

RESEARCH DESIGN AND METHODS In REDEEM, 392 adults with T2DM and DD were randomized to computer-assisted self-management (CASM), CASM plus DD-specific problem solving (CAPS), or a computer-administered minimal supportive intervention. Primary outcomes were Diabetes Distress Scale (DDS) total, the Emotional Burden (EB) and Regimen Distress (RD) DDS subscales, and diet, exercise, and medication adherence.

RESULTS Significant and clinically meaningful reductions in DD (DDS, EB, and RD) and self-management behaviors occurred in all three conditions (P < 0.001), with no significant between-group differences. There was, however, a significant group × baseline distress interaction (P < 0.02), in which patients with high baseline RD in the CAPS condition displayed significantly larger RD reductions than those in the other two conditions. RD generated the most distress and displayed the greatest distress reduction as a result of intervention. The pace of DD reduction varied by patient age: older patients demonstrated significant reductions in DD early in the intervention, whereas younger adults displayed similar reductions later. Reductions in DD were accompanied by significant improvements in healthy eating, physical activity, and medication adherence, although not by change in HbA1c.

CONCLUSIONS DD is malleable and highly responsive to intervention. Interventions that enhance self-management also reduce DD significantly, but DD-specific interventions may be necessary for patients with high initial levels of DD. Future research should identify the minimal, most cost-effective interventions to reduce DD and improve self-management.

Footnotes

  • Clinical trial reg. no. NCT00714441, clinicaltrials.gov.

  • The opinions expressed are those of the authors and do not necessarily represent those of the National Institutes of Health, National Cancer Institute, or the National Institute of Diabetes and Digestive and Kidney Diseases.

  • Received November 30, 2012.
  • Accepted March 13, 2013.
  • © 2013 by the American Diabetes Association.

Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. See http://creativecommons.org/licenses/by-nc-nd/3.0/ for details.

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Diabetes Care: 36 (9)

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September 2013, 36(9)
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REDEEM: A Pragmatic Trial to Reduce Diabetes Distress
Lawrence Fisher, Danielle Hessler, Russell E. Glasgow, Patricia A. Arean, Umesh Masharani, Diana Naranjo, Lisa A. Strycker
Diabetes Care Sep 2013, 36 (9) 2551-2558; DOI: 10.2337/dc12-2493

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REDEEM: A Pragmatic Trial to Reduce Diabetes Distress
Lawrence Fisher, Danielle Hessler, Russell E. Glasgow, Patricia A. Arean, Umesh Masharani, Diana Naranjo, Lisa A. Strycker
Diabetes Care Sep 2013, 36 (9) 2551-2558; DOI: 10.2337/dc12-2493
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