Editorial: Psychological Interventions to Improve Diabetes Self-Management

meta-analysis

McGuigan et al. reported the design of a diabetes-focussed intervention to address psychological barriers to injectable treatments by utilising a behavioural change framework among people with T2D. Approximately 80% of patients discontinue or interrupt injectable regimens soon after commencement: suggesting that this issue is complex, related to broader adherence issues. Poor engagement and adherence are attributed to psychological barriers such as negative perceptions of injectables, depression, anxiety, feelings of shame, distress and perceived lack of control.
The authors based this intervention on a systematic review which identified a need for structured diabetes education focussed on psychological constructs to inform effective interventions to improve the initiation of and persistence with injectable medication for T2D. This systematic review along with findings from focus groups were translated to develop an intervention for people with T2D transitioning to injectable therapies, named Overcoming and Removing Barriers to Injectable Treatment in T2D (ORBIT). This intervention comprised identifying the barriers to commencing injectables and pairing these with a broad range of techniques (including education, CBT techniques and utilising supports) to help the patient in overcoming the barriers. Lowry et al. described a novel intervention called D1 Now which was designed to support self-management and engagement in order to improve outcomes in young adults (18-25 years) living with type 1 diabetes (T1D). It has been developed using a user-centred approach, and incorporating theoretical elements resulting in a three-fold intervention. One of the central components of this intervention is the availability of a Support Worker to provide continuity and build relationships with young adults and their diabetes team.
In this pilot RCT, the Support Worker provided an accessible point of contact for young adults, including conversations about distress, and developing goal setting and collaborative problem solving interventions. Diabetes distress was common in this population and was associated with challenges including cognitive distortions (e.g. 'all or nothing' thinking patterns) and disordered eating behaviours. The Support Worker advocated for the young person with T1D with the diabetes team by explaining the challenges and barriers to care elicited in their interactions. This pilot has identified that the role of the Support Worker was viewed positively from the perspective of young adults with T1D.
O'Donnell et al. described the theoretical underpinnings and development of a psychological intervention for parents of young people with T1D aged 11-14. This theoretically informed intervention was designed in recognition of the higher incidence of disordered eating and clinical eating disorders in young people with T1D. Where present comorbid with T1d, disordered eating is associated with negative outcomes in physical and mental health, including repeated diabetic ketoacidosis and hyperglycaemia. There is growing evidence that disordered eating in T1D may be effectively prevented through psychological intervention. This is a manualised intervention and includes two online group workshops, supplemented by additional online materials intervention was co-developed with an expert advisory group of clinicians, and families of young people with T1D. The findings of the feasibility study will inform the future alignment of this intervention with routine diabetes care. This interventions has the potential to improve the psychological and physical wellbeing of young people with T1D.

CONCLUSION
These diverse papers demonstrate the range of psychological interventions which may be utilised to optimise the management of both T1D and T2D, and indicate that different psychological approaches may be required for different challenges, for example a support worker may be effective for the young adult population, but a population with disordered eating may require a more tailored intervention, and specific interventions to address individual-level barriers to commencing injectable therapies may have promise. Four papers do not of course offer a comprehensive overview of the area of psychological therapies in diabetes, but they provide a glimpse of emerging treatment. There is much work to be done in further refining the right intervention for the individual challenges that the person with diabetes may face, and these studies indicate that a personcentred approach to finding solutions to the individual's specific problems may be approaches which will shape the evidence in the future.

AUTHOR CONTRIBUTIONS
The author confirms being the sole contributor of this work and has approved it for publication.