Optimising the Delivery of Diabetes Distress Informed Care for Its Prevention, Detection, and Management in Adults With Type 1 Diabetes: a Feasibility Study (D-stress Study)

Optimising the Delivery of Diabetes Distress Informed Care for Its Prevention, Detection, and Management in Adults With Type 1 Diabetes: a Feasibility Study (D-stress Study)

Up to one in two adults with type 1 diabetes find living with and managing diabetes to be emotionally challenging. This 'emotional side' of diabetes - feeling worried, frustrated, overwhelmed, sad, burnt-out - is called diabetes distress. It affects people's quality of life and can hinder them from managing their diabetes as well as they can.

In the UK, the NHS needs to better understand how to best support people feeling emotionally burdened by diabetes. So, we have worked with diabetes distress specialists around the world to develop an NHS pathway to care for diabetes distress. This pathway to care involves training diabetes teams to recognise, assess and talk about diabetes distress at routine appointments. If people have a high diabetes distress level, they may be able to take part in an online group program to help them manage their type 1 diabetes and emotions. The feasibility study will test this pathway to care with people with type 1 diabetes in the NHS setting.

Inclusion Criteria:

Adults with type 1 diabetes

• People aged 18 years old and older
• With a T1DM diagnosis of more than one year
• Who used a Continuous Glucose Monitoring device 3 months prior to trial entry

Health care professionals

• Members of the multidisciplinary diabetes team
• Who would like and be able to undertake training in Enhanced Usual Care (EUC)

Family or friend

• People aged 18 years or older
• Is involved with the care of the participant
• The participant has consented to the family member or friend to be involved in the study

REDUCE Facilitators

• Eligibility as per the role specification in Section 6.2.2 of study Protocol

Exclusion Criteria:

Adults with type 1 diabetes

• Exclusion criteria will include those adults diagnosed less than one year ago. This is because the first 12 months following a diagnosis of T1DM is a period of unique stress due to the diagnosis, the acute onset, and requirement to learn complex new skills. Additionally, due to the honeymoon period, which can typically last up to a year, there is variety in the physiological trajectory which might have an impact that would be difficult to measure and account for in this study(Sokołowska, Chobot et al. 2016).
• Women who are pregnant. This is because the additional burdens and anxieties this population is confronted with may risk confounding the trial findings
• Exclusion of adults with current mental health diagnoses with current symptoms (e.g. psychosis or substance abuse or severe depression), will be evaluated and determined on a case-by-case basis by clinical care teams.

Health care professionals • People who are unwilling or unable to take on additional workload associated with D-stress e-learning and delivery of Enhanced Usual Care.

Family or friend

• Participant with type 1 diabetes has not given consent for a family member or friend to participate in the study

REDUCE Facilitators

• • Professional accreditation with one of the following professional bodies: Nursing & Midwifery Council, Health & Care Professionals Council, British Association for Counselling & Psychotherapy, and UK Council for Psychotherapy.
• Professional or personal understanding of Type 1 diabetes
• Professional or personal understanding of NHS diabetes care and guidelines
• Professional or personal understanding of diabetes distress
• Professional understanding of mental and emotional health
• Professional experience of in-person and/or online group facilitation especially in managing diverse needs within a group and the expression of strong emotions
• Willingness to be a research participant