CBT Linked to Improving Depression Symptoms in Adults with Type 1 Diabetes

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Internet-based cognitive behavior therapy (CBT) is associated with reducing depressive symptoms but not improving glycemic control in adults with type 1 diabetes facing mild-moderate depressive symptomatology, according to a new study.¹

Individuals with type 1 diabetes have a higher prevalence of depression than the rest of the population, affecting quality of life. According to the World Health Organization, depression affects roughly 1 in 4 people with diabetes.² Previous studies found online CBT improves depression and diabetes-specific distress but did not affect glycemic control.

The same findings ring true for a new study, led by Mónica Carreira, from the department of personality, assessment, and psychological treatment at the University of Malaga in Malaga, Spain.¹ The study wanted to implement a similar study in Spain, with an aim to see if CBT treatment for adults with type 1 diabetes and mild-moderate depressive symptomatology improved depression and variables linked to depression like quality of life, anxiety, diabetes-related stress, and adherence to treatment.

“The results were positive, and the program was effective in reducing depressive symptomatology, a finding consistent with earlier studies,” the investigators wrote. “Regarding diabetes-related distress, the second outcome analyzed in the aforementioned studies, the treatment program reduced diabetes-related distress, with positive results both on the general scale and on the four subscales of distress (Emotional, Physical, Treatment Regimen, and Interpersonal).”

The investigators recruited participants from January 2017 – March 2019. To be included, individuals needed to have a medical diagnosis of type 1 diabetes for >1 year, were >18 years old, had mild-moderate depressive symptoms, internet access, no other pharmacological treatment that could affect blood glucose levels or depressive symptomatology, no present psychological treatment, and they could not have chronic renal failure, impaired liver function tests, active thyroid disease, pregnancy, acute ketosis decompensation.

Once collecting their sample, the team computer randomized 65 participants into the treatment group (n = 35) and the control group (n = 30). The CBT program included 9 sessions and assessed depression through the Beck Depression Inventory Fast Screen (BDI-FS), hemoglobin (HbA1c), anxiety through the State Trait Anxiety Inventory (STAI), fear of hypoglycemia through the Fear of Hypoglycemia Questionnaire (FH-15), distress through the Diabetes Distress Questionnaire (DDS), quality of life through the Diabetes Quality of Life Questionnaire (DQOL), and treatment adherence through the Diabetes Self-Care Inventory-Revised questionnaire (SCI-R).

At baseline, the treatment and control group did not have significant differences at baseline for both sociodemographic, clinical, or heath habits variable nor psychological variables. After the CBT program, Carreira and colleagues noted change differences between the two groups in depressive symptoms, quality of life (for dissatisfaction, impact, social worry), anxiety, treatment adherence, and total diabetes-related stress in emotional, physical, and impersonal subscales. Moreover, participants in the treatment group had significant improvements on the Beck Depression Inventory Fast Screen, the total Diabetes Quality of Life Questionnaire,

Meanwhile, the investigators observed no changes in glycemic control, quality of life in the diabetes worry subscale, fear of hypoglycemia, and the regimen diabetes-related stress.

“Although the people who have completed the [treatment group] have presented improvements in depressive symptoms, quality of life, anxiety, distress and adherence to treatment with respect to the participants of the [control group], in some variables (the quality-of-life subscale social worry, fear of hypoglycemia and physical, treatment regimen and interpersonal distress) no significant differences have been found despite improving their scores with respect to the [control group],” the investigators wrote. “It is possible that the passage of time and being involved in a study could have caused an improvement in these areas in the [control group].

The investigators continued by adding the sample size could have influenced the results. If participants in the treatment group did not complete all their required tasks, they were omitted from the study, as the team only included evaluations of the people who completed the 9 required sessions. The investigators noted reasons individual left the program, such as not having time due to work, family issues, issues with using the computers or technology, and worsening symptoms.

“These reasons suggest that, although the technology is effective, it is not a universal treatment, but specific for people with specific characteristics, such as a specific profile of motivation,” the investigators concluded.

^References

1. ^{Carreira M, Ruiz de Adana MS, Pinzón JL, Anarte-Ortiz MT. Internet-based cognitive-behavioral therapy is effective in reducing depressive symptomatology in type 1 diabetes: results of a randomized controlled trial. Front Clin Diabetes Healthc. 2023;4:1209236. Published 2023 Nov 7. doi:10.3389/fcdhc.2023.1209236}
2. ^{Type 1 Diabetes Depression. JDRF. https://www.jdrf.org/t1d-resources/living-with-t1d/mental-health/depression/#:~:text=According%20to%20the%20World%20Health,type%201%20and%20type%202). Accessed December 4, 2023.}