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Talking therapies can help control diabetes

NOVEMBER 17, 2008

New research findings published today by researchers at the Institute of Psychiatry at King’s College London demonstrate that psychological interventions delivered by diabetes specialist nurses can help people with type 1 diabetes improve their glycaemic control.  The paper is published in the American medical journal The Annals of Internal Medicine.

There is currently an epidemic of diabetes in the UK and despite the intensive medical regimens set up for patients many people have difficulties in getting good diabetes control.  Psychological problems, such as low mood, eating problems and worries and fears, related to having and living with the condition can interfere with an individual’s confidence and ability to care for their diabetes.   

This new study showed that the combination of motivational therapy with cognitive behavioural therapy (CBT) techniques resulted in a modest but significant improvement in long-term blood glucose control over 12 months. Motivational enhancement therapy (MET) is a brief counselling to help people have better confidence and motivation to change the way they look after their diabetes.  CBT is a longer approach that helps people to develop new skills and strategies in coping and managing their diabetes.

Dr Khalida Ismail lead researcher and clinical reader at the Institute of Psychiatry at King’s said: “Traditional ways of treating people with type 1 diabetes are giving way to a more psychological understanding of the person living with diabetes as a chronic condition.  It’s increasingly clear that diabetes services need to include a range of skills in psychological care such as management of depression, eating problems and helping the person to develop better coping strategies and conditions to improve their diabetes self care.”

She continued: “Diabetes affects around 3-4% of the general population and the incidence of type 1 and type 2 diabetes in childhood and adolescence is increasing.  The condition and its complications impose significant social and economic consequences on individuals, families, health systems and countries.  It is also associated with several mental health problems so it is important for health professionals working in diabetes to learn some basic psychological interventions.”

Based on this study’s findings, Dr Stephen Thomas, the lead diabetologist at Guy’s and St Thomas’ Hospital said “Now researchers can train diabetes nurses to deliver these talking treatments to a high standard, important for adapting them for use in the NHS.” 

Diabetes is a chronic disease that occurs when the pancreas does not produce enough insulin, or when the body cannot effectively use the insulin it produces.  This leads to hyperglycemia or raised blood sugar, which if left untreated over time leads to serious damage to many of the body’s systems, especially the nerves and vessels.  Type 1 diabetes represents around 10 per cent of all cases of diabetes and is characterized by total or near total lack of insulin.  Type 2 diabetes accounts for 90 per cent of all cases and results from the body’s ineffective use of insulin.

The study’s researchers will be turning their attention to developing a better understanding of what techniques work for whom and how.  They would like to refine, adapt and test their interventions further in different groups such as adolescents, and also for people with type 2 diabetes.

The research project was led by the Institute of Psychiatry, King’s College London with the London School of Hygiene and Tropical Medicine and the University of Manchester as collaborators.  The Diabetes centres that participated included King’s College, Guy’s and St Thomas’, Lewisham and Mayday and North Manchester General, Stepping Hill (Stockport) and Manchester Royal Infirmary.

The paper’s authors are: Khalida Ismail, Stephen M Thomas, Esther Maissi, Trudie Chalder , Ulrike Schmidt, Jonathan Bartlett, Anita Patel, Christopher M Dickens, Francis Creed, J Treasure.  They were supported in their research by: Health Technology Assessment Programme, Department of Health, United Kingdom.

The paper is entitled ‘Motivational Enhancement Therapy with and without Cognitive Behavioural Therapy and Control of Type 1 Diabetes: A Randomized Controlled Trial. ‘and is published in The Annals of Internal Medicine (
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