Abstract
<p dir="ltr"><b>Objective: </b>To compare the effectiveness of three interventions to reduce diabetes distress (DD) and improve HbA1c among adults with type 1 diabetes (T1D).</p><p dir="ltr"><b>Research design and methods: </b>Individuals with T1D (<i>n</i>=276) with elevated DD (>2 on T1 Diabetes Distress Scale) and HbA1c<sub> </sub>(>7.5%) were recruited from multiple settings and randomly assigned to one of three virtual group-based programs: (1) Streamline, an educator-led education and diabetes self-management program; (2) TunedIn, a psychologist-led program focused exclusively on emotional-focused DD reduction; or (3) FixIt, an integration of Streamline and TunedIn. Assessments of the primary outcomes of DD and HbA1c occurred at baseline, and at 3, 6, and 12 months.</p><p dir="ltr"><b>Results: </b>All three programs demonstrated substantive and sustained reductions in DD (Cohen’s <i>d</i>= 0.58 to 1.14) and HbA1c (Δ -0.4 to -0.72) at 12-month follow-up. TunedIn and FixIt participants reported significantly greater DD reductions compared to Streamline participants (<i>p</i>=.007). Streamline and TunedIn participants achieved significantly greater HbA1c reductions than FixIt participants (<i>p</i>=.006).</p><p dir="ltr"><b>Conclusions: </b>DD can be successfully reduced among distressed individuals with T1D with elevated HbA<sub>1c</sub> using both the education/behavioral and emotion-focused approaches included in the study. While both approaches are associated with significant and clinically meaningful reductions in DD and HbA1C, TunedIn, the emotion-focused program, displayed the most consistent benefits across both DD and HbA1c. Group-based, fully virtual and time limited, these findings suggest the overall value of emotion focused strategies, like those utilized in TunedIn, for adults with type 1 diabetes.</p>
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