People diagnosed with diabetes are three times more likely to be diagnosed with depression than people without it and this can have a serious impact on their ability to self manage their condition.
PsychologyOnline has secured Small Business Research Initiative for Healthcare (SBRI Healthcare) funding to see how its approach to cognitive behaviour therapy (CBT) can be used to treat “diabetes distress”, a term used to describe the sense of frustration, anger and disillusionment that can lead to neglecting the condition over time.
The collaborative project aims to improve glycaemic control and psychological wellbeing through integrated care. It is led by Ann Hayes, chairman of PsychologyOnline, alongside Professor Khalida Ismail, who leads the Diabetes and Mental Health clinical service at King's College Hospital and Bruce Hellman, founder of uMotif, a health and wellbeing app.
Ann Hayes says the project will investigate the benefits of delivering CBT over the internet to type 1 diabetics: “PsychologyOnline provides one-to-one CBT via instant messaging and we use highly-experienced psychotherapists. Patients with chronic conditions may, however, find it more helpful to have therapy from someone who is also knowledgeable about their condition.
“We will be working with King’s College Hospital to train diabetes specialist nurses (DSN) to provide CBT integrated with structured diabetes education and will pilot this approach in a small focused patient study.”
Prof Ismail, a specialist in liaison psychiatry, has previously developed e-learning for GPs and is very interested in the potential for online CBT.
She says: “Around a third of patients have psychological issues interfering with their confidence to manage their diabetes.
“Living with diabetes requires lifelong skills in calculating insulin doses and carbohydrate portions, taking into account physical activity. It is therefore understandable that some people may need psychological support from time to time to help them build their confidence towards effective blood glucose control.
“On the other hand, people with diabetes also have busy lives so trying to find the time and money to travel and attend face-to-face therapy sessions on top of the diabetes appointments is not always possible.
“I am very interested to investigate how online CBT integrated into usual diabetes care delivered by a specialist nurse can be used to provide an effective intervention.”
To further help the patient self-manage their treatment, the project is investigating the benefit of a health and wellbeing app being developed by uMotif, which helps patients to monitor their condition and provides motivational support, as well as reminders about medication.
Bruce Hellman of uMotif says: “Patients will be supported to improve their self-management of diabetes through tracking and monitoring aspects of health such as sleep quality, blood glucose levels, mood, or physical activity levels. The app empowers patients and can help strengthen relationships with clinicians, by viewing and using the medical data in context.
“This project will include integration of uMotif with PsychologyOnline, to help patients and nurses to maximise the beneficial outcomes from the therapy and keep motivated.”
Depression is treatable. When an individual is distressed or anxious, they tend to perceive themselves and their situation in a negative way. Everyone has these moments, but when someone feels low every day for more than two weeks and it can start to impact his or her ability to cope then it becomes a concern. This is especially true in diabetes where strict adherence to a diet and medication regime is vital to maintain quality of life.
Research has found that people who suffer from both diabetes and depression have poorer metabolic and glycemic control which has, in turn, can intensify symptoms of depression.
CBT-trained DSNs will work with an individual to help them to see for themselves the link between negative thoughts and mood and how this impacts on their decisions about their diabetes management. This empowers people to gain control over their negative emotions and provides mechanisms for coping.
PsychologyOnline appointments are made with the same nurse for the duration of the treatment and sessions can take place wherever the patient feels most comfortable. All that is required is a computer, tablet or smartphone connected to the internet.
Following the successful completion of this pilot, the team is hoping to secure further funding for a full clinical trial.
This work will be funded by the NHS England - funded by SBRI and commissioned by Papworth Hospital NHS Foundation Trust. The views expressed in the publication are those of the author(s) and not necessarily those of the funding partner or Papworth Hospital NHS Foundation Trust.