Status psicologico, autoefficacia e controllo glicemico nel diabete tipo 2: studio trasversale e studio randomizzato controllato per valutare l’efficacia di un intervento psicologico nel migliorare il controllo glicemico

PROJECT I – CROSS-SECTIONAL STUDY Psychological distress, self-efficacy and glycemic control in type 2 diabetes. Background: Psychological distress and poorer glycemic control are strongly associated together in people affected by diabetes mellitus. Higher diabetes-related self-efficacy is associated with both better glycemic control and increased engagement in self-care behaviors. Poor behavioral adherence to diabetic regimen (diet and physical activity) may lower self-efficacy, which would lead, in turn, to a higher likelihood of depressive symptoms. This study aimed to investigate the association among psychological distress, glycemic control and self-efficacy in type 2 diabetes (T2D). Subjects and Methods: One-hundred seventy-two subjects with T2D were consecutively recruited from the Verona Diabetes Center. Standard biochemical parameters and the following survey batteries were assessed in all study participants: the Beck Depression Inventory (BDI-II) to assess the severity of depression; the Beck Anxiety Inventory (BAI) to assess the level of anxiety; the Binge Eting Scale (BES) to assess the severity of binge eating; the Multidimensional Diabetes Questionanire to assess the psychosocial adjustment of patients to diabetes. Results: Age, body-mass index (BMI) and glucose control (HbA1c) were (mean±SD) 62.6±7.5 years, 31.4±4.0 Kg/m², 7.5±1.2% respectively. Prevalence of clinically detectable anxiety and depression was 14.5% and 18.6%, respectively. Self-efficacy was inversely correlated with HbA1c (r=-0.21, p=0.005), BMI (r=-0.25, p=0.001) and with psychological distress, a composite endpoint comprised of depression (r=-0.37, p<0.001), anxiety (r=-0.28, p<0.001) and binge eating (r=-0.48, p<0.001). HbA1c was positively correlated with perceived interference (r=0.33, p<0.001) and perceived severity of diabetes (r=-0.14, p=0.001). No correlation was found between HbA1c and psychological distress (depression: r=0.019, p=0.80; anxiety: r=0.10 p=0.15; binge eating: r=0.14, p=0.07). Conclusions: Psychological distress was highly prevalent in a sample of T2D Italian patients. Despite psychological distress and glycemic control were not related to each other, we found that a lower sense of self-efficacy was significantly related to a poorer glycemic control, increased adiposity and a higher prevalence of depression and anxiety. Our data highlight the key role of self-efficacy in the management of T2D and suggest that interventions focused on improvement of self-efficacy may favorably impact both clinical and psychological diabetes outcomes. Project II – Randomized Clinical Trial Effects of psychological intervention on glycemic control and psychological distress in type 2 diabetic patients Background: Increasing evidence suggests that psychological disorders play an important role in the development and worsening of type 2 diabetes (T2D). Among the spectrum of psychological disorders, there is a wide literature about the association between depression and T2D and current data show an approximately two-fold prevalence of depression in adults affected by diabetes compared to un-affected subjects. Moreover, depression in diabetic patients is associated with higher blood glucose levels, poorer adherence to therapeutic regimens (whether pharmacological or therapeutic lifestyle changes), more medical complications, and higher hospitalization rates. Nevertheless, at the best of our knowledge, the mechanism underlying the association between depression and adverse diabetes-related outcomes is currently unresolved. Aim of this project is to assess the efficacy of a psychological treatment for diabetic patients with suboptimal level of Hemoglobin A1c. Subjects and Methods: 55 subjects, 25 females and 30 males were randomized to two treatment arms standard diabetes care or 24 individual sessions of psychological intervention. Those who agreed to take part in the study completed survey batteries at the end of the study (T26) and at 12-week follow-up (T38). Results: Among those who completed the 24-week study evaluation the intervention group showed lower HbA1c (p=0.02) and BMI (p=0.005)), markedly reduced anxiety e depression and higher perceived self-efficacy ) (p<0.001) compared to the control group at the end of the study. Among those subjects who completed the follow-up evaluation (N=38) there were not significant differences on measures of glycemic control (p=0.84) and BMI (p=0.47) from baseline (T0) to follow-up (T38). About psychological measures, at follow-up it was confirmed a significant decrease of anxiety (p=0.019) and depression (p=0.035) but not of binge eating (p=0.12), while it was confirmed a significant increase of diabetes self-efficacy (p<0.001). Conclusion: The data showed a significant decrease of psychological distress among type 2 diabetic patients after 24 weeks of psychological intervention added to standard medical care.