There were no significant mean reductions for body mass index or serum cholesterol .
Nurse-led interventions produced greater improvements than ' usual care ' for HbA1c , serum triglyceride and smoking cessation and support an increased independent role for nurses in diabetes management
A randomised controlled trial of cognitive behaviour therapy and motivational interviewing for people with Type 1 diabetes mellitus with persistent sub-optimal glycaemic control: a Diabetes and Psychological Therapies (ADaPT) study.
OBJECTIVES To determine whether ( i ) motivational enhancement therapy ( MET ) + cognitive behaviour therapy ( CBT ) compared with usual care , ( ii ) MET compared with usual care , ( iii ) or MET + CBT compared with MET was more effective in improving glycaemic control when delivered by general nurses with additional training in these techniques . DESIGN A three-arm parallel r and omised controlled trial as the gold st and ard design to test the effectiveness of psychological treatments . SETTING The recruiting centres were diabetes clinics in seven acute trusts in south-east London and Greater Manchester . PARTICIPANTS Adults ( 18 - 65 years ) with a confirmed diagnosis of type 1 diabetes for a minimum duration of 2 years and a current glycated ( or glycosylated ) haemoglobin ( HbA1c ) value between 8.2 % and 15.0 % . INTERVENTIONS The control arm consisted of usual diabetes care which varied between the hospitals , but constituted at least three monthly appointments to diabetes clinic . The two treatments arms consisted of usual care with MET and usual care with MET + CBT . MAIN OUTCOME MEASURES The primary outcome was HbA1c at 12 months from r and omisation . Secondary outcome measures were 1-year costs measured by the Client Service Receipt Inventory at baseline , 6 months and 12 months ; quality of life-years [ quality -adjusted life-years ( QALYs ) ] measured by the SF-36 ( Short Form-36 Health Survey Question naire ) and EQ-5D ( European Quality of Life-5 Dimensions ) at baseline and 12 months . RESULTS One thous and six hundred and fifty-nine people with type 1 diabetes were screened and 344 were r and omised to MET + CBT ( n = 106 ) , MET ( n = 117 ) and to usual care ( n = 121 ) . The 12-month follow-up rate for HbA1c was 88 % ( n = 305 ) . The adjusted mean 12-month HbA1c was 0.45 % lower in those treated with MET + CBT [ 95 % confidence interval ( CI ) 0.16 % to 0.79 % , p = 0.008 ] than for usual care ; 0.16 % lower in those treated with MET ( 95 % CI 0.20 % to 0.51 % , p = 0.38 ) than for usual care ; and 0.30 % lower with MET + CBT than with MET ( 95 % CI -0.07 % to 0.66 % , p = 0.11 ) . The higher the HbA1c , and the younger the participant at baseline , the greater was the reduction in HbA1c . The interventions had no effect on secondary outcomes such as depression and quality of life . The economic evaluation was inconclusive . Both interventions were associated with increased health care costs than for usual care alone . There was no significant difference in social costs . Cost effectiveness ratios , up to one year , varied considerably according to whether QALY estimates were based on EQ-5D or SF-36 and whether imputed or complete data were used in the analyses . CONCLUSIONS A combination of MET and CBT may be useful for patients with persistent sub-optimal diabetic control . MET alone appears less effective than usual care . Economic evaluation was inconclusive . TRIAL REGISTRATION Current Controlled Trials IS RCT N77044517
There were no significant mean reductions for body mass index or serum cholesterol .
Nurse-led interventions produced greater improvements than ' usual care ' for HbA1c , serum triglyceride and smoking cessation and support an increased independent role for nurses in diabetes management