Toward effective interventions to reduce diabetes distress among adults with type 1 diabetes: Enhancing Emotion regulation and cognitive skills.

Objective: We tested three models to determine how improvements in emotion regulation (ER) and cognitive skills (CS) as a result of intervention operate to affect reductions in diabetes distress DD.

Methods: Change data were drawn from the baseline and 9-month T1-REDEEM trial. Adults with type 1 diabetes were recruited from several U.S. states and Toronto, Canada. A primary and two alternative structural equation models were tested to explore the directionality of effect: primary model - changes in ER and CS drive changes in DD; reverse model - changes in DD drive changes in ER and CS; and bidirectional model - changes in ER, CS and DD occur together with no directionality.

Results: All three models displayed a good fit to the data. The primary model indicated 7 significant directional pathways: improvements in ER and CS operate together to drive reductions in DD. The reverse model only indicated that reductions in DD affected changes in one CS variable; and the bidirectional model indicated only that these results were bidirectional. Reductions in all tested domains of DD occurred together.

Conclusions: Improvements in ER and CS drive reductions in DD.

Practice Implications: Interventions to reduce high DD should focus on improving ER and CS.