problem solving treatment for diabetes in individuals with poor diabetes control

Conditions: Diabetes Mellitus, Type 2

Summary: the goal of this randomised controlled trial is to test a cognitive-behavioural intervention, problem solving treatment for diabetes (pst-d) in patients with type 2 diabetes. the main questions it aims to answer are: * to evaluate the clinical effectiveness of pst-d compared with the attention control group. * to determine the impact of pst-d on patient-centred, behavioural, and psychosocial outcomes. * to identify independent factors associated with an improvement in hba1c and reductions in incidence and progression diabetic retinopathy, diabetic neuropathy, diabetic peripheral neuropathy, and visual impairment at 18-month follow-up in both groups; and determine if these factors mediate the associations between the pst-d intervention with the above outcomes. * to quantify the incremental cost-effectiveness of pst-d compared with the attention control group at 18-month follow-up. * to understand participants' views, experiences, and opinions about pst-d; and the barriers and facilitators to program completion. participants will complete blood tests, ocular examinations, and a series of questionnaires at baseline, 6-month, 12-month, and 18-month follow-up. participants will also complete the intervention/ control group sessions conducted over the phone, video call, or face-to-face depending on the participant's preference. researchers will compare the intervention group against the attention control group to determine the effectiveness of pst-d on improving clinical, patient-centred, behavioural, and psychosocial outcomes.

assuming the recent rise in obesity prevalence persists, the lifetime risk of diabetes in singapore will almost double by 2050. poorly controlled diabetes leads to various diabetes-related complications which may consequently require costly lifelong treatment and have a profound impact on patients' quality of life. based on a previous trial on problem solving therapy in people with diabetic retinopathy and significant levels of distress, the investigators have designed a cognitive-behavioural intervention which aims to teach individuals skills to cope with and solve problems related to diabetes self-management. this novel intervention will be carried out at one tertiary hospital in singapore, with the option for interested community-dwelling individuals with diabetes to participate, to facilitate its implementation and transition to the real world setting to assist patients with diabetes.

Eligibility criteria:
inclusion criteria: * patients with type 2 diabetes and at least 1 recent reading of suboptimal glycaemic control (hba1c ≥7.0%) * able to speak english and/or mandarin * singapore citizens or those with singapore permanent residency status * aged 21 years and above * no cognitive impairment, as assessed using the 6-item cognitive impairment test (6cit) * adequate hearing with/without hearing aids to respond to normal conversation * consent to participate in the sessions if randomised to the pst-d treatment arm exclusion criteria: * have hearing or cognitive impairment compromising consent or study procedures * all recent hba1c readings are \<7.0% * uncontactable or unwilling/unable to participate in all the pst-d sessions if randomised to the pst-d group

Keywords: diabetes problem solving treatment hba1c sugar control