ACT Now! Guided self-help to improve self-management and emotional wellbeing type 2 diabetes

Abstract

Background: Our aim was to evaluate ACT Now!, a brief, manualised, guided self-help intervention designed to improve diabetes control and emotional wellbeing in people with Type 2 diabetes. Methods: A prospective cohort study. ACT Now! consisted of up to 8 appointments complimented by web-based support that reinforced education, goals, provided expert advice, and patient-stories. Based on acceptance and commitment therapy, values (the important aspects of people’s lives) were used as motivation, rather than health itself. Participants were adult’s diagnosed ≥12 months previously with Type 2 diabetes, and most recent HbA1c ≥61mmol/mol. We recruited from primary and secondary care. We measured anxiety, depression (HADS), diabetes-related distress (PAID), and activity levels (Fitbit pedometer) at baseline and post-intervention. Diabetes control (HbA1c) was obtained at baseline and 3 month follow-up. Wilcoxon-signed rank tests were used to evaluate changes over time, and Cohen’s d was calculated. Findings: We had post-intervention data on 35? participants and HbA1c data on 27. Participants did not differ significantly from the local Type 2 population on age, years since diagnosis, BMI and deprivation. Compared to baseline, follow-up mean HbA1c was 7.2 mmol/mol lower (p<0.05, d=0.18). Post-intervention, people walked 13,546 steps further per week (≈6.7miles, p<0.001, d=0.61), and had significantly lower levels of anxiety (p<0.001, d=0.61), depression (p<0.001, d=0.52) and diabetes-related distress (p<0.001, d=0.55). Discussion: ACT Now! is a promising low-resource intervention that may be effective in improving diabetes control and reducing anxiety, depression and diabetes-related distress. Further research is warranted.