Psychological Variables and Hyperglycemia in Diabetes Mellitus (ALEXIDIAB)

We want to investigate if a specific group educational method - The Affect School - can improve the blood sugar levels of patients with diabetes who have difficulties managing their disease and at the same time show signs of psychological and emotional problems such as depression and alexithymia (difficulties identifying and describing feelings)

Our primary hypothesis is that more patients with diabetes have emotional problems such as alexithymia than the general population and that this impairs their abilities to manage their diabetes disease.

Our secondary hypothesis is that a group intervention directed at recognizing feelings and discerning them from body signals caused by the diabetes disease would improve the patients' abilities to manage their diabetes disease.

Background:

Depression is common in patients with diabetes and is associated with impaired metabolic control. Alexithymia has been associated with depression, anxiety, stress related disorders and diabetes mellitus. Affect School (AS) is an intervention that may reduce depression and alexithymia according to previous research. Basic Body Awareness Therapy (BBA) is a stress-reducing technique.

Purpose:

Our aim is to: 1. Analyze the prevalence of depression and anxiety and the personality variables alexithymia and self image in diabetes patients. 2. Explore correlations between these variables and risk factors, including biochemical markers for diabetic complications. 3. To evaluate an intervention with AS and BBA in patients with diabetes that scored high in psychometric self-report tests and at the same time showed impaired metabolic control.

Method:

A randomized controlled trial of 350 people with diabetes, 18-59 years, 56% men, 44% women. Base-line study: from medical records and the National Diabetes Registry - waist circumference, BMI, blood pressure, type and duration of diabetes, diabetes complications, other diseases, medications, exercise habits and smoking. Tests - A1c, blood lipids, cytokines, hormones, beta-cell antibodies, c-peptide, midnight cortisol (salivary). Self-report tests of psychological and personality variables: HAD, TAS-20, SASB. Intervention: patients with A1c ≥ 8 and anxiety (HAD ≥ 8), depression (HAD ≥ 8), negative self-image (SASB: AFF <284) or alexithymia (TAS-20 ≥ 61) were randomized to AS or BBA. AS: 8 group sessions followed by 10 individual sessions. Instructors were a primary care physician and a psychotherapist. BBA: 9 group meetings and 6 individual sessions with a physiotherapist as instructor. Post intervention: Self report tests, A1c, cytokines, hormones, cortisol.

• Diabetes Mellitus
• Depression
• Alexithymia
• Anxiety

• Behavioral: Affect School
• Behavioral: Body Awareness Therapy
• Behavioral: Treatment as usual

• Active Comparator: Treatment as usual
  No active intervention
  Intervention: Behavioral: Treatment as usual
• Active Comparator: Affect School
  Psychological group education intervention
  Intervention: Behavioral: Affect School
• Active Comparator: Body Awareness Therapy
  Physiotherapeutic psychosomatic intervention
  Intervention: Behavioral: Body Awareness Therapy

Inclusion Criteria:

• Type 1 and type 2 diabetes at a specialist outpatient clinic in Vaxjo, Sweden

Exclusion Criteria:

• Other severe somatic disorder, including being deaf or blind.
• Severe psychiatric disorder requiring psychiatric specialist care;
• psychotic disorder,
• bipolar disorder,
• severe drug abuse.
• Inadequate knowledge of Swedish.