As a Diabetes Educator who participated in the EMBARK trial, I have first-hand experience with the three different approaches used in this study to address diabetes distress and glucose levels for adults living with type 1 diabetes. I am surprised by the findings and excited to share them.
But before I describe the study and its results, there is a spoiler alert—the research results might compel you to adjust your practice approach.
The EMBARK (Behavioral Approaches to Reducing Diabetes Distress and Improving Glycemic Control) study was a 12-month randomized, controlled intervention trial for adults with type 1 diabetes. It directly compared the impact of three highly focused interventions designed to reduce both Diabetes Distress and A1C levels among adults with Type 1 Diabetes.
The trial divided participants into three groups: Streamline, FixIt, and TunedIn. As a diabetes educator, I participated in the Streamline and FixIt study groups. As part of the study protocol, each participant completed the Diabetes Distress Scale and the results were shared with the study facilitators.
As a diabetes educator involved in the Streamline and FixIt groups, I was sure that the FixIt group would have the best outcomes, given that they received the “Rolls-Royce” of interventions, which included several group sessions and one-on-one coaching by a team of psychologists and diabetes educators. However, I was wrong. The psychologist-led “TunedIn” had the best overall outcomes.
The findings suggest the value of using emotion-focused strategies, like those in TunedIn, to reduce diabetes distress and enhance management among adults with diabetes. In truth, the findings reveal that all three groups experienced improvement in A1C and Diabetes Distress. These results suggest that both management- and emotion-focused group programs for adults with type 1 diabetes can lead to significant and clinically meaningful reductions in Diabetes Distress and A1C.
As healthcare professionals, we tend to focus on problem-solving around lifestyle, medications, and glucose levels. The results of this study confirm our intuition to prioritize addressing emotions to support individuals living with diabetes.
Let’s reprioritize our checklist of diabetes topics and move into the heart of providing effective diabetes care by assessing and addressing distress.
This emotion-based approach aligns with the 2024 American Diabetes Standards, which recommend annually assessing Diabetes Distress. These important study results remind and prompt us to assess and address Diabetes Distress to improve diabetes care outcomes. The ADA created a wonderful resource, the ADA Behavioral Health Toolkit, which houses diabetes distress and other screening tools for easy reference.
The year I spent coaching study participants in the Embark Trial significantly changed my approach to diabetes self-management coaching. In preparation for the study intervention, we were fortunate to be mentored by two experts in the field of diabetes distress: Susan Guzman, PhD, and Larry Fisher, PhD. Their wisdom and role-modeling of empowering individuals to discover new approaches to self-management were truly remarkable.
Danielle M. Hessler, Lawrence Fisher, Susan Guzman, Lisa Strycker, William H. Polonsky, Andrew Ahmann, Grazia Aleppo, Nicholas B. Argento, Joseph Henske, Sarah Kim, Elizabeth Stephens, Katherine Greenberg, Umesh Masharani; EMBARK: A Randomized, Controlled Trial Comparing Three Approaches to Reducing Diabetes Distress and Improving HbA1c in Adults With Type 1 Diabetes. Diabetes Care 2024; dc232452. https://doi.org/10.2337/dc23-2452
If you are interested in providing a FREE Diabetes Distress program led by a team of experts for the health care professionals in your facility, Please download this Diabetes Distress Flyer for more info!
Session 1 is ready for viewing | Session 2 airs July 3rd
This two-session training provides the essential steps to address diabetes distress combined with an innovative approach to helping people make sense of their glucose data.
The first session is team-taught by experts in the field of diabetes distress and effective communication approaches. Dr. Larry Fisher kicks off the program by describing the difference between depression and distress and interpreting Diabetes Distress screening results. Dr. Susan Guzman uses a case study approach and step-by-step communication strategies to address responses from the Diabetes Distress screening tool. This session includes an abundance of evidence-based approaches that you can apply in your clinical setting.
Coach Beverly leads the second session. During this three-hour program, Beverly describes insulin dosing strategies, meter and sensor data interpretation, and common issues encountered by people using diabetes technology. Case studies include tools to help individuals discover what changes are needed to get glucose to target, coupled with the communication skills discussed in the first session. In conclusion, the team of instructors review a case study that pulls together all the ReVive 5 elements.
Can’t join live? That’s okay. Your registration guarantees you access to the recorded version of the series, along with podcasts and resources for one full year.
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Team of Experts:
ReVive 5 is taught by a team of 3 Interdisciplinary Experts:
Accreditation: Diabetes Education Services is an approved provider by the California Board of Registered Nursing, Provider 12640, and our CPEU courses have received Prior Approval* from the Commission of Dietetic Registration (CDR), Provider DI002. Since our CPEU courses received Prior approval* from the CDR, these CPEU courses satisfy the CE requirements for the CDCES /BC-ADM regardless of your profession!
The use of DES products does not guarantee the successful passage of the certification exam. CBDCE and ADCES do not endorse any preparatory or review materials for the CDCES or BC-ADM exams, except for those published by CBDCE & ADCES.
The use of DES products does not guarantee the successful passage of the certification exam. CBDCE and ADCES do not endorse any preparatory or review materials for the CDCES or BC-ADM exams, except for those published by CBDCE & ADCES.
Diabetes Education Services offers education and training to diabetes educators in the areas of both Type 1 and Type 2 Diabetes for the novice to the established professional. Whether you are training to be a Certified Diabetes Care and Education Specialist (CDCES), practicing at an advanced level and interested in board certification, or a health care professional and/or Certified Diabetes Care and Education Specialist (CDCES) who needs continuing education hours to renew your license or CDCES, we have diabetes education information, resources and training; learning and teaching tools; and diabetes online courses available for continuing education (CE). Read our disclaimer for full disclosure.