REAL Diabetes study reveals how implementing occupational therapy strategies can help patients achieve glycemic goals.
Young adults with diabetes often encounter new experiences as they enter adulthood. They must transition from parent-driven care to having to take responsibility for their disease management. As with most conditions, diabetes presents a variety of challenges, including the aspects of self-management. Diabetes care includes but is not limited to blood glucose monitoring, medication adherence, dietary requirements, and more.
In recent years, occupational therapy (OT) has been used in the management of chronic conditions like type 1 and 2 diabetes. OT is a practice that assesses an activity at various levels followed by identification of barriers that could inhibit the performance of an activity. At that point, therapists implement strategies to help patients combat any challenges that could impede optimal diabetes management. For diabetes, one common challenge is insulin injection. In this example, an occupational therapist might recommend different techniques to injecting if pain is an issue or even recommend relaxation techniques to reduce the stress of the event.
The Resilient, Empowered, Active Living with Diabetes (REAL Diabetes) study was developed to assess the use of OT in young adults with type 1 or 2 diabetes coming from low socioeconomic communities. The study design used was a two-arm, parallel, randomized controlled trial. Eighty-one participants were placed in either the intervention group or control group in a 1:1 manner. Inclusion criteria was as follows: 1) 18-30 years old, type 1 or 2 diabetes for ≥ 1 year, HbA1c ≥ 8%, and meet low socioeconomic status criteria. The primary outcome sought to determine if OT would improve self-management (i.e. improve glycemic control, HbA1c). Additionally, secondary outcomes, like diabetes self-care, diabetes-related QOL (ADDQOL), diabetes distress, symptoms of depression, and life satisfaction were assessed.
The intervention group, those who received occupational therapy, were treated using the Lifestyle Redesign OT intervention framework. This method analyzes an activity associated with health management with the aim to prevent or manage a chronic disease. The study did try to account for the Hawthorne effect within the control group, through the provision of at-home visits, follow-up phone calls, and education materials.
The primary outcome, change in HbA1c at 6 months from baseline, for the intervention group was shown to be significant compared to the control group (-0.57% vs +0.36%; p = 0.01). Analysis of secondary outcomes showed significant improvements in two areas. Firstly, diabetes-related QOL was better in the intervention group compared to the control group (change in ADDQOL +0.7 vs +0.15; p = 0.04). Secondly, habit strength, specifically self-monitoring of blood glucose (change in SRBAI +3.9 vs + 1.7; p = 0.05) showed significant improvements compared to the control group. Another finding was the within-group difference found in the intervention group. Recall patients with either type 1 or 2 diabetes were included; analysis found that those within the intervention group with type 1 diabetes showed HbA1c reductions (-0.84%) compared to the control group, which showed minimal reductions (-0.03). Patients in the intervention group with type 2 diabetes showed slight increases in HbA1c (0.2%) while the control group showed dramatic increase (1.58%).
Previous studies have shown that interventions, like the ones here, yielded reductions in HbA1c and improvements in psychosocial well-being. But no studies, to date, have shown improvements in quality of life. All in all, the REAL Diabetes study supports the use of OT in the management of diabetes. Beyond improving glycemic control, OT can improve the outlook a person with diabetes has on their disease as seen by QOL score improvement. Furthermore, OT interventions can reinforce habits important to diabetes care like blood glucose monitoring.
The REAL Diabetes trial provided further evidence supporting the use of OT in diabetes care. But as with most, additional studies are needed to discern if OT would be beneficial in other populations as well as ascertain if differences truly exist when OT interventions are used in both type 1 and 2 diabetes.
- The REAL Diabetes study show that occupational therapy is a possible option for patients struggling to achieve glycemic targets.
- The addition of occupational therapy to a diabetes regimen can improve diabetes-related quality of life.
- In patients having difficulty with tasks, like self-monitoring of blood glucose, occupational therapy has shown positive effects and can strengthen habits important to self-management of diabetes.
Pyatak, E., Carandang, K., Vigen, C., Blanchard, J., Diaz, J., Concha-Chavez, A., Sequeira, P., Wood, J., Whittemore, R., Spruijt-Metz, D., and Peters, A. Occupational Therapy Intervention Improves Glycemic Control and Quality of Life Among Young Adults With Diabetes: the Resilient, Empowered, Active Living with Diabetes (REAL Diabetes) Randomized Controlled Trial. Diabetes Care. 41.4 (2018): 696-704. https://doi.org/10.2337/dc17-1634.
Kaytie A. Weierstahl, Pharm.D. Candidate, LECOM School of Pharmacy