Brief CBT Interventions Delivered by Nurse Care Managers to Improve Type 2 Diabetes Outcomes: Pilot Study
Condition: Diabetes Mellitus, Type 2
MeSH terms: Diabetes Mellitus; Diabetes Mellitus, Type 2
Study type: Interventional

Summary: 
      Primary aim: examine feasibility and acceptability of a brief cognitive therapy protocol for
      type II diabetes administered by nurse care managers or health coaches via phone.
    

Detailed description: 
      A significant problem in primary care healthcare delivery is the lack of interventions to
      improve medication and overall regimen adherence in persons with Type 2 diabetes (T2DM).
      Diabetes distress, a negative response to the diagnosis of T2DM, danger of complications, and
      self-management burdens is present in up to 70% of persons with T2DM. Distress is a
      significant factor in medication nonadherence and poor glycemic control. Treatment adherence
      is vital to maintain glucose control and reduce complications.

      The literature has identified dysfunctional thinking patterns such as beliefs (e.g., I can't
      handle taking these medications), assumptions (e.g., I know I will have side effects to these
      medications) and interpretations (e.g., I'm too overwhelmed to do all of this stuff) as
      critical variables that impact both distress and T2DM treatment adherence. Current treatment
      strategies within primary care do not address the dysfunctional thinking patterns that affect
      the patient's distress level, T2DM medication adherence, and complex daily self-care
      activities.

      Cognitive behavior therapy (CBT), a well-established evidenced-based treatment, helps
      patients to identify, and restructure dysfunctional thinking patterns. We propose to test a
      brief CBT approach delivered by nurse care managers and supported by a comprehensive mobile
      phone CBT skills practice application (app) within primary care. The promising results of our
      preliminary studies using a mobile phone app to stimulate real-time CBT skills practice
      prompt us to propose a pilot of its use with patients with T2DM with the following aims:

      Primary aim: examine feasibility and acceptability of the assessment protocol, and the
      recruitment, and retention of study participants.

      Secondary aim: 1) collect preliminary data on the effect of the intervention on clinical
      outcomes, e.g., self-reported adherence to medication and self-management adherence, e.g.,
      diet, exercise; levels of diabetes distress, diabetes medication beliefs, and distal T2DM
      outcomes (HbA1c level and body mass index).
    

Intervention name(s): Brief CBT
Intervention type(s): Behavioral
Intervention description(s): During the course of the twice/month diabetes management phone sessions the nurse care manager will work collaboratively with the patient to identify a dysfunctional belief that may be affecting adherence and could be improved by a brief CBT intervention (5-7 minutes). The care manager will utilize the CBT phone app to identify a CBT intervention that will be most appropriate for the situation. Each intervention is described step by step in the app. The nurse will go through the intervention and when completed will assure the patient's understanding.CBT interventions are geared towards helping the patient identify and restructure thinking that is impairing successful self-management of a chronic disease
Other intervention name(s): CBT MobileWork
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Brief CBT; smartphone app; mHealth; diabetes distress; adherence; cognitive behavioral therapy