A trial of cognitive analytic therapy in poorly controlled type I patients.
OBJECTIVE
This study compared the effect of cognitive analytic therapy (CAT), a focused time-limited psychotherapy, and diabetes specialist nurse education (DSNE) in a controlled trial of 26 chronically poorly controlled adult type I patients.


METHODS
Patients were randomized to either 16 sessions of CAT (treatment) or 14-18 sessions of DSNE (control). Pre- and post-treatment blood glucose control (HbA1), interpersonal difficulties, and diabetes knowledge were measured before and up to 9 months after treatment was completed.


RESULTS
Although HbA1 levels improved in the DSNE group, at the end of treatment (mean fall 1.2%, P = 0.004) this was not maintained; so by the 9-month follow-up, the overall net fall was limited to 0.9% (P = 0.03 vs. entry value). There were no significant improvements in interpersonal difficulties in DSNE subjects at any retest point (P > 0.05). In contrast, glycemic control and interpersonal difficulties both improved after CAT. In contrast to DSNE, this improvement continued so that at the 9-month follow-up visit, the changes were significant (mean fall in HbA1 = 2%, P = 0.002 and P = 0.03 for the Inventory of Interpersonal Problems [IIP] scores).


CONCLUSIONS
These results suggest that although there is no statistical difference between CAT and DSNE, the effects of CAT produce a more prolonged effect on glycemic control. If psychological difficulties underlying problems with self-care in a type I population are addressed, then improvements in diabetes control are likely to continue.
Fosbury
J A
JA
Department of Medicine, UMDS at St Thomas' Hospital, London, U.K. a.broome@umds.ac.uk
Bosley
C M
CM
Ryle
A
A
Sönksen
P H
PH
Judd
S L
SL
D000328:Adult; D001786:Blood Glucose / Q000378:metabolism*; D015928:Cognitive Behavioral Therapy; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000523:psychology* / Q000534:rehabilitation; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007398:Interpersonal Relations; D008297:Male; D010353:Patient Education as Topic; D011614:Psychotherapy, Brief
D001786:Blood Glucose; D006442:Glycated Hemoglobin