OBJECTIVE To compare the effectiveness of three interventions to reduce diabetes distress (DD) and improve HbA1c among adults with type 1 diabetes (T1D). RESEARCH DESIGN AND METHODS Individuals with T1D (n = 276) with elevated DD (a score >2 on the total Type 1 Diabetes Distress Scale) and HbA1c (>7.5%) were recruited from multiple settings and randomly assigned to one of three virtual group-based programs: 1) Streamline, an educator-led education and diabetes self-management program; 2) TunedIn, a psychologist-led program focused exclusively on emotional-focused DD reduction; or 3) FixIt, an integration of Streamline and TunedIn. Assessments of the primary outcomes of DD and HbA1c occurred at baseline and at 3, 6, and 12 months. RESULTS All three programs demonstrated substantive and sustained reductions in DD (Cohen’s d = 0.58–1.14) and HbA1c (range, −0.4 to −0.72) at 12-month follow-up. TunedIn and FixIt participants reported significantly greater DD reductions compared with Streamline participants (P = 0.007). Streamline and TunedIn participants achieved significantly greater HbA1c reductions than did FixIt participants (P = 0.006). CONCLUSIONS DD can be successfully reduced among individuals with T1D with elevated HbA1c using both the educational/behavioral and emotion-focused approaches included in the study. Although both approaches are associated with significant and clinically meaningful reductions in DD and HbA1c, TunedIn, the emotion-focused program, had the most consistent benefits across both DD and HbA1c. The study findings suggest the overall value of group-based, fully virtual, and time-limited emotion-focused strategies, like those used in TunedIn, for adults with T1D.

中文翻译：

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EMBARK：一项随机对照试验，比较三种减轻糖尿病困扰和改善 1 型糖尿病成人 HbA1c 的方法


目的 比较三种干预措施在减轻成人 1 型糖尿病 (T1D) 糖尿病困扰 (DD) 和改善 HbA1c 方面的有效性。研究设计和方法 从多个环境中招募 DD（总 1 型糖尿病应激量表得分为 >2）和 HbA1c (>7.5%) 升高的 T1D 个体 (n = 276)，并随机分配到三个组之一基于虚拟小组的计划：1) Streamline，一项由教育工作者主导的教育和糖尿病自我管理计划； 2) TunedIn，一个由心理学家主导的项目，专门致力于减少以情绪为中心的 DD；或 3) FixIt，Streamline 和 TunedIn 的集成。 DD 和 HbA1c 主要结局的评估在基线以及 3、6 和 12 个月时进行。结果 所有三个项目在 12 个月的随访中均显示出 DD（Cohen's d = 0.58–1.14）和 HbA1c（范围，-0.4 至 -0.72）的实质性和持续降低。 TunedIn 和 FixIt 参与者报告称，与 Streamline 参与者相比，DD 减少量显着增加 (P = 0.007)。 Streamline 和 TunedIn 参与者的 HbA1c 降低幅度显着高于 FixIt 参与者 (P = 0.006)。结论 使用研究中包含的教育/行为和以情绪为中心的方法，可以成功减少 HbA1c 升高的 T1D 患者的 DD。尽管这两种方法都可显着且具有临床意义的 DD 和 HbA1c 降低，但以情绪为中心的 TunedIn 项目在 DD 和 HbA1c 方面具有最一致的益处。研究结果表明，基于小组、完全虚拟且限时的情绪聚焦策略（如 TunedIn 中使用的策略）对于成人 T1D 具有整体价值。