Problem-solving therapy for adults with diabetic retinopathy and diabetes-specific distress: a pilot randomized controlled trial

Gwyneth Rees; Fleur O'Hare; Marian Saeed; Bronwyn Sudholz; Bonnie A Sturrock; Jing Xie; Jane Speight; Ecosse L Lamoureux

doi:10.1136/bmjdrc-2016-000307

Problem-solving therapy for adults with diabetic retinopathy and diabetes-specific distress: a pilot randomized controlled trial

BMJ Open Diabetes Res Care. 2017 Feb 9;5(1):e000307. doi: 10.1136/bmjdrc-2016-000307. eCollection 2017.

Authors

Gwyneth Rees¹, Fleur O'Hare¹, Marian Saeed¹, Bronwyn Sudholz², Bonnie A Sturrock¹, Jing Xie¹, Jane Speight³, Ecosse L Lamoureux⁴

Affiliations

¹ Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, University of Melbourne , Melbourne , Australia.
² Deakin University, Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Geelong, Australia; Deakin University, School of Psychology,Geelong, Australia.
³ Deakin University, School of Psychology,Geelong, Australia; The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, Victoria, Australia; AHP Research, Hornchurch, UK.
⁴ Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, University of Melbourne, Melbourne, Australia; Singapore Eye Research Institute, National University of Singapore, Singapore, Singapore; Duke-NUS Medical School, Singapore, Singapore.

Abstract

Objective: To provide preliminary evidence for the impact of problem-solving therapy for diabetes (PST-D) in adults with diabetic retinopathy (DR) and diabetes distress.

Research design and methods: In a pilot randomized controlled trial, 40 participants with DR and diabetes distress were allocated to the PST-D or control groups. Diabetes distress (DDS), depressive symptoms (PHQ-9), self-care activities (SDSCA), and HbA_1c were assessed at baseline, and 3 and 6-month follow-ups.

Results: At the 6-month follow-up, the PST-D group showed significant improvements relative to the control group, in 'regimen-related distress' (PST-D: -1.3±1.4; control: -0.4±1.1), depressive symptoms (PST-D: -4.3±6.1; control: -0.3±4.6), and HbA_1c (PST-D: -1.2%±1.01; control: 0.2%±1.2%) (all p<0.05). In multiple regression analysis, adjusting for baseline values and sociodemographic factors, PST-D was associated with significant improvement in 'regimen-related distress', depressive symptoms, and HbA_1c at the 6-month follow-up (p<0.05).

Conclusions: PST-D is a promising intervention for improving psychological outcomes and glycemic control. A fully powered study is required to confirm these findings and examine mechanisms of change in HbA1c.

Trial registration number: ACTRN12616001010482; results.

Keywords: Psychological Aspects; Psychology/Behavior; Psychosocial Depression; Retinopathy.