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The effect of guided self-determination on self-management in persons with type 1 diabetes mellitus and HbA1c ≥64
Jannike Mohn1,2,3, Marit Graue1,4, Jõrg Assmus5
1Centre for Evidence-Based Practice, Western Norway University of Applied Sciences, Bergen, Norway.
Insights
Guided self-determination group training (GSD-GT) did not improve HbA1c in type 1 diabetes patients. However, GSD-GT significantly reduced diabetes distress and improved self-esteem and autonomy-motivated behavior.
Area of Science:
- Behavioral Medicine
- Endocrinology
- Psychology
Background:
- Type 1 diabetes mellitus (DM) requires ongoing self-management.
- Chronically elevated HbA1c levels indicate poor glycemic control.
- Psychological well-being is crucial for managing chronic conditions like DM.
Purpose of the Study:
- To evaluate the effectiveness of guided self-determination group training (GSD-GT) compared to usual care.
- To assess the impact of GSD-GT on HbA1c and psychological functioning in adults with type 1 DM.
- To determine if GSD-GT improves diabetes-related distress, self-esteem, and motivation.
Main Methods:
- 178 adults with type 1 DM and elevated HbA1c were randomized to GSD-GT or a control group.
- The GSD-GT intervention involved seven 2-hour sessions over 14 weeks.
- Outcomes, including HbA1c and psychological measures, were assessed at 9 months post-intervention.
Main Results:
- GSD-GT did not significantly impact HbA1c levels (B -0.18, p=0.234).
- Significant improvements were observed in autonomy-motivated behavior (B 0.51, p<0.001).
- Diabetes distress (PAID, DDS) and self-esteem showed significant reductions and improvements, respectively.
Conclusions:
- GSD-GT did not improve glycemic control (HbA1c) in individuals with type 1 DM.
- The intervention positively impacted psychological outcomes, notably reducing diabetes distress.
- Recruitment and attrition challenges necessitate cautious interpretation of findings, despite improved psychological well-being.
Objectives:
To determine whether the impact of guided self-determination (GSD) applied in group training (GSD-GT) in people with chronically elevated HbA1c and type 1 diabetes mellitus (DM) was superior to 'care as usual' in improving HbA1c and psychological functioning.
Setting:
An outpatient clinic at a university hospital in Western Norway.
Participants:
A total of 178 adults (all Caucasian) aged 18-55 (mean age 36.7±10.7, 62% women) with type 1 DM for at least 1 year and HbA1c ≥64 mmol/mol (8.0%) were randomly assigned to participate in either GSD-GT or a control group (CG). Exclusion criteria were severe comorbidity, major psychiatric disorder, cognitive deficiency/language barriers and pregnancy.
Intervention:
Intervention group met seven times for 2 hours over 14 weeks to promote patient autonomy and intrinsic motivation using reflection sheets and advanced professional communication in accordance with the GSD methodology.
Primary And Secondary Outcome Measures:
The primary outcome was HbA1c and secondary outcomes (all outcomes 9 months post intervention) were self-monitored blood glucose frequency, self-reported diabetes competence, autonomy support by healthcare providers (Health Care Climate Questionnaire), autonomous versus controlled diabetes motivation (Treatment Self-Regulation Questionnaire), diabetes distress (Problem Areas In Diabetes Scale (PAID) and Diabetes Distress Scale (DDS)), self-esteem (Rosenberg Self-Esteem Scale) and psychological well-being (World Health Organization five-item Well-Being Index scale).
Results:
Among participants allocated to the GSD-GT (=90) 48 completed the study, whereas 83 completed in the CG (n=88). With 95% CIs GSD-GT did not have effect on HbA1c (B -0.18, CI (-0.48, 0.12), p=0.234). GSD-GT improved autonomy-motivated behaviour (B 0.51, CI (0.25, 0.77), p<0.001), diabetes distress (PAID, B -6.96, CI (-11.40, -2.52), p=0.002), total DDS (B -5.15, CI (-9.34, -0.96), p=0.016), DDS emotional burden (B -7.19, CI (-13.20, -1.19), p=0.019) and self-esteem (B 1.43, CI (0.34, 2.52), p=0.011).
Conclusions:
Results from this behavioural intervention must be interpreted cautiously because of recruitment and attrition problems. Medical outcomes did not improve. Psychological outcomes improved, especially reduced diabetes distress.
Trial Registration Number:
Clinical Trials.gov NCT 01317459.
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