A TRIAL OF COGNITIVE ANALYTIC THERAPY IN POORLY CONTROLLED TYPE-I PATIENTS

OBJECTIVE - This study compared the effect of cognitive analytic thera py (CAT), a focused time-limited psychotherapy, and diabetes specialis t nurse education (DSNE) in a controlled trial of 26 chronically poorl y controlled adult type I patients. RESEARCH DESIGN AND METHODS - Pati ents were randomized to either 16 sessions of CAT (treatment) or 14-18 sessions of DSNE (control). Pre- and post-treatment blood glucose con trol (HbA(1)), interpersonal difficulties, and diabetes knowledge were measured before and up to 9 months after treatment was completed. RES ULTS - Although HbA(1) levels improved in the DSNE group, at the end o f treatment (mean fall 1.2%, P = 0.004) this was not maintained; so by the g-month follow-up, the overall net fall was limited to 0.9% (P = 0.03 vs. entry value). There were no significant improvements in inter personal difficulties in DSNE subjects at any retest point (P > 0.05). In contrast, glycemic control and interpersonal difficulties both imp roved after CAT. In contrast to DSNE, this improvement continued so th at at the 9-month follow-up visit, the changes were significant (mean fall in HbA(1) = 2%, P = 0.002 and P = 0.03 for the Inventory of Inter personal Problems [IIP] scores). CONCLUSIONS - These results suggest t hat although there is no statistical difference between CAT and DSNE, the effects of CAT produce a more prolonged effect on glycemic control . If psychological difficulties underlying problems with self-care in a type I population are addressed, then improvements in diabetes contr ol are likely to continue.