A Trial of Cognitive Analytic Therapy in Poorly Controlled Type I Patients

OBJECTIVE: This study compared the effect of cognitive analytic therapy (CAT), a focused time-limited psychotherapy, and diabetes specialist nurse education (DSNE) in a controlled trial of 26 chronically poorly controlled adult type I patients. RESEARCH DESIGN AND METHODS: Patients were randomized to either 16 sessions of CAT (treatment) or 14-18 sessions of DSNE (control). Pre- and post-treatment blood glucose control (HbA1), interpersonal difficulties, and diabetes knowledge were measured before and up to 9 months after treatment was completed. RESULTS: Although HbA1 levels improved in the DSNE group, at the end of treatment (mean fall 1.2%, P = 0.004) this was not maintained; so by the 9-month follow-up, the overall net fall was limited to 0.9% (P = 0.03 vs. entry value). There were no significant improvements in interpersonal difficulties in DSNE subjects at any retest point (P > 0.05). In contrast, glycemic control and interpersonal difficulties both improved after CAT. In contrast to DSNE, this improvement continued so that at the 9-month follow-up visit, the changes were significant (mean fall in HbA1 = 2%, P = 0.002 and P = 0.03 for the Inventory of Interpersonal Problems [IIP] scores). CONCLUSIONS: These results suggest that although there is no statistical difference between CAT and DSNE, the effects of CAT produce a more prolonged effect on glycemic control. If psychological difficulties underlying problems with self-care in a type I population are addressed, then improvements in diabetes control are likely to continue.