Behavioral treatments have long been used in the management of diabetes. A study by Ismail and coworkers sought to determine whether motivational enhancement therapy, with or without cognitive behavior therapy, improved glycemic control in type 1 diabetes compared with usual care. A randomized, controlled trial was conducted at 8 diabetes centers in London and Manchester, United Kingdom. The subjects were 344 adults with type 1 diabetes for longer than 2 years, with hemoglobin A(1c) levels of 8.2% to 15%, and without complications or severe comorbid disease. The treatment consisted of nurse-delivered motivational enhancement therapy (4 sessions over 2 months), motivational enhancement therapy plus cognitive behavior therapy (12 sessions over 6 months), or usual care. Outcome measures included 12-month changes in hemoglobin A(1c) levels (primary outcome), and hypoglycemic events, depression, quality of life, fear of hypoglycemia, diabetes self-care activities, and body mass index (secondary outcomes). An analysis including all randomly assigned patients found that 12-month change in hemoglobin A(1c) levels, compared with usual care, was -0.46% in the motivational enhancement therapy plus cognitive behavior therapy group and -0.19% in the motivational enhancement therapy group alone. There was no evidence of treatment effects on secondary outcomes.

WHAT THE STUDY MAY MEAN TO YOU AS A PRIMARY CARE PROVIDER: The authors concluded that nurse-delivered motivational enhancement therapy and cognitive behavior therapy is feasible for adults with poorly controlled type 1 diabetes. Combined therapy resulted in modest 12-month improvement in hemoglobin A(1c) levels compared with usual care, but motivational enhancement therapy alone did not.

WHAT THE STUDY MAY MEAN TO YOU AS A PATIENT: The treatment tested proved effective with patients with type 1 diabetes. This finding, as in other entries on the site, suggests you should ask to receive cognitive behavioral treatment, particularly self-management training, if you experience either type of diabetes. The accumulated data overwhelmingly suggests that in learning and performing behavioral treatments, you can make a contribution to controlling diabetes.

K Ismail et al. Motivational Enhancement Therapy with and without Cognitive Behavior Therapy to Treat Type 1 Diabetes: A Randomized Trial. Annals of Internal Medicine, 2008, 18;149:708-719.