Simple Discussion of Emotions Reduces Diabetes Distress in Malaysia

Becky McCall

September 19, 2017

LISBON, PORTUGAL — Discussion of emotions related to diabetes, social support, and opinions on healthcare services is effective in reducing high diabetes distress in patients with type 2 diabetes, show results of a study evaluating the results of an educational program in Malaysia.

In fact, the findings show that simple discussion around emotions  — as was used in the control group in this study — was as effective as a more complex and expensive educational program in this population.

The study, Value-Based Emotion-Cognition-Focused Educational Program to Reduce Diabetes Distress in Adults With Type 2 Diabetes (VEMOFIT), was carried out by Boon-How Chew, MD, from the Julius Center for Health Sciences and Primary Care, Utrecht, the Netherlands, and the University Putra Malaysia, Serdang, Malaysia.

He presented the results in a session dedicated to the importance of psychological studies in improving diabetes care at the European Association for the Study of Diabetes (EASD) 2017 Annual Meeting

The study aimed to test the effectiveness of the VEMOFIT program in Malay adults with type 2 diabetes and high diabetes distress. VEMOFIT was compared with a simpler and less expensive attention-control program.

"We found that Malay adults with type 2 diabetes, with high diabetes distress and suboptimal diabetes control, had significantly lower diabetes distress after receiving additional support on top of usual care," reported Dr Chew.

Specifically, he explained that providing additional healthcare-provider attention for these patients with severe diabetes distress, "on the diabetes-related emotional experience, the quality of social support at home, and listening to their opinion on the clinic services [the control program] improved their level of diabetes distress, self-care, and disease control at 6 months of follow-up."

In fact, Dr Chew emphasized that the findings showed no differences between the intervention (VEMOFIT) vs control groups, noting that the latter was "as good as the more structured and elaborate educational program."

"It shows that giving at least two sessions of extra attention to an individual's health is equally effective compared with the theory-based and more expensive, structured VEMOFIT program." However, he highlighted that this kind of simple attention-control program needs to be tested against standard diabetes care.

Emphasizing the importance of diabetes distress as a feature of type 2 diabetes, Dr Chew said that tackling it is associated with improvements in psychological well-being, health-related quality of life, medications adherence, self-care, depression, and even morbidity and mortality.

In Malaysia, 30% of type 2 diabetes patients experience moderate diabetes distress and 20% suffer severely from this, he said.

Commenting on the work, Claes-Goran Ostensen, MD, from the Karolinska University Hospital, Stockholm, Sweden, pointed out the importance of obtaining data on diabetes distress from countries outside of Europe and the United States. "I think the whole session addressed a very important issue, not only in Malaysia, but other countries too."

"We know there is a bilateral association between diabetes and depression, so one condition can predispose to the other," he added.

VEMOFIT vs Simple Discussion of Emotions, Care, and Services

The trial compared patients allocated to either the VEMOFIT program or to the attention-control group. A total of 124 patients from 10 public-health centers across both urban and suburban areas were included. Measurements were taken at baseline, immediately postintervention, and at 6 months afterward.

VEMOFIT consisted of four sessions over a period of 6 weeks that provided information on proper perceptions of type 2 diabetes, managing emotions, and goal-setting. Patients in this group, who attended with their spouse, also received one booster session at 3 months postintervention and one meeting 6 months postintervention.

Those in the attention-control program attended three sessions at 2 weeks, 8 weeks, and 8 months, respectively, after study start. Sessions in this latter group lasted 2 hours each. The attention-control group discussed emotional experiences, social support, and health clinic services.

The primary outcome was the proportion of patients in each group with a DDS-17 score of less than 3 (nonsevere distress) at 6 months. The DDS-17 is a 17-item scale that captures four critical dimensions of distress: emotional burden, regimen distress, interpersonal distress, and physician distress.

Secondary outcomes included illness perception, depressive symptoms, health-related quality of life, and diabetes self-care. Depressive symptoms were measured with the 9-item Patient Health Questionnaire (PHQ-9), and diabetes self-care was measured with the 12-item Summary of Diabetes Self-Care Activities.

A total of 53 patients were randomized to the VEMOFIT intervention and 71 to the attention-control group. Baseline characteristics were similar, with mean age 55 years in both groups, disease duration was 7 vs 8 years in the intervention vs control groups, around 60% were women, and HbA1c levels were 9.9% vs 9.5%.

At baseline, the mean DDS-17 score was significantly higher in the intervention compared with the control group (3.4 vs 3.1).

Immediately after the intervention, participants in the VEMOFIT program had a three times higher odds of having nonsevere DDS-17 score compared with those in the control group (adjusted odds ratio, 3.18; 95% CI 1.004–10.085).

But at 6 months postintervention, mean diabetes distress score changed from 3.4 to 2.9 in the intervention group (< .001), and from 3.1 to 2.7 in the control group (< .001).

"The decrease was similar in both groups," reported the researcher.

With respect to reduction in severe diabetes distress, the decrease was similar in the intervention and the control arm, from 89% to 46% vs 66% to 40%, respectively.

There were also no significant between-group differences in all secondary outcomes.

Addressing the study limitations, given the lack of effect seen between the two groups, Dr Chew said, "It is possible that it was underpowered to detect a difference due to a lower-than-estimated sample size...and the overall loss to follow-up was 18.8%."

Dr Chew and Dr Eriksson have declared no relevant financial relationships.

European Association for the Study of Diabetes (EASD) 2016 Annual Meeting. September 13, 2017, Lisbon, Portugal. Abstract 136

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