Key result
The HOPE telehealth intervention trended toward improving overall diabetes distress compared with enhanced usual care, but the difference was not significant.
Why the study?
Diabetes distress is underrecognized and associated with poor outcomes, motivating evaluation of a telehealth intervention to reduce distress levels.
Does a collaborative, goal-setting, and behavioral telehealth intervention reduce diabetes distress in individuals with uncontrolled diabetes and depression?
RCT (n=225)
randomized
Does a collaborative, goal-setting, and behavioral telehealth intervention reduce diabetes distress in individuals with uncontrolled diabetes and depression?
Answers are grounded in this paper and cite their sources.
A 12-month telehealth intervention for patients with uncontrolled diabetes and depression yielded clinically meaningful but not statistically significant overall reductions in diabetes distress over time compared to enhanced usual care.
Background: Diabetes distress is underrecognized and associated with poor outcomes. This study tested whether a 12-month collaborative, goal-setting, and behavioral telehealth intervention reduced diabetes distress levels. Methods: This is a secondary analysis of the Healthy Outcomes through Patient Empowerment (HOPE) study that included individuals (N = 225) with uncontrolled diabetes and depression living at least 20 miles from a Veteran's Affairs medical center. Participants were randomized to HOPE (intervention) or Enhanced Usual Care (EUC) with education. We evaluated diabetes distress levels as measured by the Problem Areas in Diabetes (PAID) Questionnaire and its four subscales (emotional, diabetes management, social, and treatment distress) at baseline, 6, and 12 months. Results: Between-group analysis revealed greater improvements in HOPE versus EUC for: 6-month PAID total score ( p = 0.04), emotional ( p = 0.03), and social ( p = 0.04) subscales; 12-month PAID total score ( p = 0.07) and emotional subscale ( p = 0.07). Within-group comparisons showed larger effect sizes for HOPE compared with EUC: 12-month PAID total scores (0.82 vs. 0.54), 6-month emotional burden (0.54 vs. 0.31), and 6-month (0.32 vs. 0.08) and 12-month (0.41 vs. 0.12) social burdens. Repeated-measures analysis evaluating treatment group and time trended toward improvement in PAID overall for HOPE compared with EUC participants, but was not statistically significant ( β = 6.96; SE = 4.35; p = 0.13). Discussion: Clinically meaningful reductions in PAID overall and the emotional and social subscales were observed in HOPE compared with EUC participants. Conclusion: Further evaluation of diabetes telehealth interventions that include other facets related to diabetes distress, including treatment, diabetes management, social, and emotional burdens, is warranted. Clinical Trial Number. NCT01572389; Clinical Trial Registry. https://clinicaltrials.gov/ct2/show/NCT01572389 .
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Vaughan et al. (2021) conducted an RCT in uncontrolled diabetes and depression (n=225). Healthy Outcomes through Patient Empowerment (HOPE) telehealth intervention vs. Enhanced Usual Care (EUC) with education was evaluated on Overall diabetes distress (PAID total score) over 12 months (β 6.96, p=0.13). The HOPE telehealth intervention trended toward improving overall diabetes distress compared with enhanced usual care, but the difference was not significant.
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