Problem Solving Treatment for Diabetes in Individuals With Poor Diabetes Control

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