title: Do the effects of psychological treatments on improving glycemic control in type 1 diabetes persist over time? A long-term follow-up of a randomized controlled trial.
abstract: OBJECTIVE
  In a randomized controlled trial, adults with Type 1 diabetes and suboptimal glycemic control who received motivational enhancement therapy (MET) plus cognitive behavioral therapy (CBT) had a greater reduction in their 12-month hemoglobin A(1c) (Hb(A1c)) than those who received usual care (UC). We tested whether improvements in glycemic control persisted up to 4 years after randomization.
  
  
  METHODS
  In the original trial, participants were randomized to UC (n = 121), 4 sessions of MET (n = 117), or 4 sessions of MET plus 8 sessions of CBT (n = 106). Of the 344 patients who participated in the original trial, 260 (75.6%) consented to take part in this posttrial study. A linear mixed model was fitted to available measurements to assess whether intervention effects on Hb(A1c) at 12 months were sustained at 2, 3, and 4 years.
  
  
  RESULTS
  Estimated mean Hb(A1c) level was lower for participants in the two intervention arms when compared with UC at 2, 3, and 4 years, but none of the differences were statistically significant. At 4 years, estimated mean Hb(A1c) level for MET plus CBT was 0.28% (95% confidence interval = -0.22% to 0.77%) lower than that for UC, and estimated mean Hb(A1c) level for MET was 0.17% (95% confidence interval = -0.33% to 0.66%) lower than that for UC.
  
  
  CONCLUSIONS
  There was no evidence of benefit for patients randomized to MET plus CBT at 2, 3, or 4 years. Larger studies are needed to estimate long-term treatment effects with greater precision. Current models of psychological treatments in diabetes may need to be intensified or include maintenance sessions to maintain improvements in glycemic control.
authors.affiliation: Institute of Psychiatry, King's College London, 10 Cutcombe Rd, London SE5 9RJ, United Kingdom.
authors.forename: Katie
authors.initials: K
authors.lastname: Ridge
authors.forename: Jonathan
authors.initials: J
authors.lastname: Bartlett
authors.forename: Yee
authors.initials: Y
authors.lastname: Cheah
authors.forename: Stephen
authors.initials: S
authors.lastname: Thomas
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Lawrence-Smith
authors.forename: Kirsty
authors.initials: K
authors.lastname: Winkley
authors.forename: Khalida
authors.initials: K
authors.lastname: Ismail
mesh_terms: D000293:Adolescent; D000328:Adult; D015928:Cognitive Behavioral Therapy; D003131:Combined Modality Therapy; D016001:Confidence Intervals; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000523:psychology / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000378:metabolism*; D006801:Humans; D016014:Linear Models; D008297:Male; D009042:Motivation; D009732:Nursing Care / Q000379:methods; D010349:Patient Compliance; D012648:Self Care / Q000523:psychology*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D006442:Glycated Hemoglobin