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Motivational Interviewing and Depression in Patients with Type 1 Diabetes

Can motivational interviewing reduce HbA1c in patients experiencing depression?

Type 1 diabetes mellitus (T1DM) makes up a small percentage of all diabetes cases. T1DM is inherently different than type 2, and patients with type 1 experience different challenges. For example, it is possible (although not probable) that patients with type 2 diabetes can “reverse” the disease if caught early enough. For patients with T1DM, that is not the case. They will always need insulin therapy and will have to manage the disease their entire lives. Roughly 25% of adults who have T1DM have persistent poor glycemic control. “Chronic high levels of blood glucose are associated with long-term damage, dysfunction, and functional failure of the heart, kidneys, nerves, and eyes, as well as blood vessels” (Begic, 2016).

Motivational interviewing is something that has been used in psychology and behavior disorders for many years. The core elements of motivational interviewing are partnership, evocation, acceptance, and compassion. While these tenants might not seem like they would align with a physiological disorder, chronic conditions can take a toll on mental health and physical health. Motivational interviewing has four fundamental processes: engaging, focusing, evoking, and planning. Sometimes the “how” of change is more challenging than the why. Motivational interviewing helps patients with “how” to change while also addressing acceptance and state of mind.

With both type 1 and type 2 diabetes, successful management of the disease is highly dependent upon an individual’s ability to abide by a strict daily treatment regimen. Specifically, patients with T1DM must make daily decisions about self-management to maintain glycemic control. In addition, diagnosis with T1DM can be an emotional experience for the patient and bring about permanent changes in the patient’s life. Chen et al. did a systematic review that revealed adolescents with both T1DM and depressive symptoms are associated with poor diabetes management. “Depression was identified to be more prevalent in T1DM cases relative to the general population, and related to poorer glycemic control and self-care and increased risk of complications” (Chen et al., 2021).

According to Chen, previous systematic reviews have focused on the intervention effect of motivational interviewing and type 2 diabetes mellitus, motivational interviewing, and non-specific diabetes mellitus. Still, they did not compare T1DM and T2DM. Patients with T1DM face problems that are very different than patients who have T2DM. There is controversy regarding motivational interviewing and its effectiveness in patients with T1DM. Chen conducted a meta-analysis to determine the effects of motivational interviewing on HbA1c and depression among cases with T1DM.

The outcomes of interest included HbA1c levels and the numerical score of depression. The depression score was measured using the Center for Epidemiologic Study-Depression (CES-D) or Well-being Questionnaire (WBQ) scale. All the outcomes were continuous data; therefore, the standard mean difference was adopted with a 95% confidence interval. A 2-tailed p-value of less than 0.05 was considered to suggest statistical significance. A total of nine studies, with 1,322 participants) satisfied the inclusion criteria: six RCTs, two pseudo-RCTs, and one self-controlled trial. The duration of the intervention (motivational interviewing) ranged from 2 to 12 months. Patients were evaluated at 3, 6, 9, and 12 months. At each interval, there was no statistical significance identified. There was not a difference in HbA1c in the control groups and the intervention groups. Motivational interviewing seemed to be no more effective than regular diabetes care. However, “Studies have found that effective patient-provider communication is positively related to treatment adherence, health outcomes, and patient satisfaction” (Chen et al., 2021)

Practice Pearls:

  • Patients with type 1 diabetes mellitus experience different challenges than patients with type 2 diabetes mellitus.
  • While motivational interviewing has been suggested to help with the “how” of change, it has not been shown to be more effective than standard diabetes care in reducing HbA1c.
  • Patient-provider communication is vital in successful disease management due to treatment adherence and patient satisfaction.

Begic E, Arnautovic A, Masic I. Assessment of risk factors for diabetes mellitus type 2. Mater Sociomed. 2016;28(3):187–90.

Chen, Y., Tian, ​​Y., Sun, X. et al. Effects of motivational interviewing on HbA1c and depression among cases with type 1 diabetes: a meta-analysis. Int J Diabetes Dev Ctries(2021). https://doi.org/10.1007/s13410-021-01003-w

Grace Behr, PharmD/MBA Candidate, Creighton University

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