How to Improve Self-Management of Type 2 Diabetes

In a study published in PLOS One, investigators assessed the effects of group-based acceptance and commitment therapy (ACT) on self-management of patients with type 2 diabetes, particularly the role of moderating factors, such as coping styles.

ACT is an empirically-based psychological intervention that involves mindfulness strategies and acceptance, as well as commitment and behavior change strategies. The goal of this form of therapy is to increase psychological flexibility. However, there are few studies published that investigate the moderating role of coping styles on the effects of ACT on diabetes self-management.

Included in the study were 106 patients, aged between 40 and 60, with type 2 diabetes. They were recruited based on a convenience sampling procedure from the endocrine clinic of the Endocrine Department of Labbafinejad Hospital in Tehran, Iran, between February 2013 and January 2014.

The pre-test, post-test, and follow-up control-group randomized trial had a 50:50 allocation ration between the intervention and comparison groups.

The participants were randomly assigned to education alone (n=53), or to a combination of education and group-based acceptance and commitment therapy (n=53) over a period of 10 sessions. Fifty participants in each group completed a 3-month follow-up assessment.

Correlation analyses showed significant negative correlations between glycated hemoglobin level and self-care activities (r = -0.62, p < .01), effective coping styles (r = -0.50, p < .01), and acceptance (r = -0.48, p < .01). Ineffective coping style was significantly and positively correlated with HbA1c levels (r = 0.24, p < .05), according to the study.

The results of a repeated Measure ANOVA analysis for evaluating the moderating role of coping styles in the relationship between the ACT group and 3 indices of diabetes control had statistically significant results for self-care activities (F_1,93 = 3.69; p < .01; partial η² = .07).

This indicated that the association between ACT and coping style was significant only in self-care activities, which further confirmed the hypothesis of the moderating role of coping style in the relationship between ACT and self-care activates, according to the study. For acceptance, the results were found to be marginally significant (F_1,93 = 2.59; p = .06; partial η² = .05)and non-significant for glycated hemoglobin (F_1,93 = 0.54; p = .58; partial η² = .01).

The investigators used a simultaneous test procedure (STP) to further clarify the effects of significant interaction between ACT and coping style—–effective, ineffective, and combined–– on self-care activities.

The results of the study showed 1 significant finding for Group ACT × Effective Coping Style (5 × F_0.15,5,97/2 = 6.45). According to investigators, the findings indicated that only type 2 diabetes patients with an effective coping style significantly increased their self-care activities after undergoing ACT.

From pre- to post-test, only the group ACT x effective coping interaction term was associated with significant improvements in self-care activities, while the ACT group x ineffective coping style and the ACT group x combined coping style were not associated with these improvements.

In the control group, no significant differences in self-care activities among the 2 interaction terms (group ACT x coping styles) were observed.

The authors noted that although the study results should be interpreted with caution, they will be useful in future research.

Some limitations to the study were no follow-up assessment was conducted that was longer than 3 months, and the long-term effects of the study could not be assessed.

Although more research needs to be done to investigate these effects, the study results showed that effective coping style is more important than ineffective coping style in ACT for self-management of patients with type 2 diabetes.