Comparison of two online ACT-based interventions for adults with insulin-treated diabetes - a pilot RCT

Sophini Logeswaran

Research output: ThesisDoctoral Thesis

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Systematic Review - Abstract

Acceptance and Commitment Therapy (ACT) has been researched as a promising approach to address the psychosocial impact of diabetes. However, a systematic review of the evidence base for ACT for diabetes has not been conducted to date. The present review aimed to explore the characteristics of ACT interventions for diabetes and to examine whether ACT improves diabetes-related outcomes in people with type 1 diabetes (T1D) and type 2 diabetes (T2D). A systematic literature search was undertaken of three databases (PubMed, Web of Science and PsycINFO) and the grey literature in September 2019 to identify any quantitative studies that have investigated the impact of ACT on diabetes-related psychological, behavioural and/or physical outcomes. Following title, abstract and full-text paper screens, 17 studies were included in the review for quality appraisal and narrative synthesis. The interventions employed in these studies varied in their delivery format, duration and components. Thirteen studies found that ACT led to improvements of small to large effect sizes for several outcomes, such as diabetes-related distress and diabetes self-management, in the T2D population. The heterogeneity of psychological outcomes hindered cross-study comparisons. Inconsistent results were identified for depression, anxiety, ACT-related processes and HbA1c. One study investigated ACT in adolescents with T1D, precluding generalisation. Three studies examined combined populations, finding post-ACT improvements in a range of outcomes, although diabetes type may have been a confounding factor. The review raised concerns regarding reporting bias and methodological issues, which may have contributed towards inconsistent results. Overall, the findings suggest that ACT may have the potential to address a future direction in diabetes care delivery, but high-quality research is needed to draw firmer conclusions about its effectiveness. Recommendations for future research include using robust study designs, reaching a consensus on standardised diabetes-related measures, and increasing transparency about ACT interventions.

Empirical Study - Abstract

The aims of the pilot study were: to investigate the impact of two online four-week, self-help interventions based on Acceptance and Commitment Therapy components (a values-plus-goals intervention [VGI] and a mindfulness-based intervention [MBI]) on well-being, diabetes self-management and glycaemic control of adults with insulin-treated diabetes; and to determine whether improvements in these outcomes were associated with changes in diabetes acceptance and valued living. A randomised controlled mixed design was employed. The final sample consisted of 29 insulin-treated adults with type 1 or 2 diabetes in the VGI (n = 17) and the MBI (n = 12) conditions. Participants completed the Well-being Questionnaire, Diabetes Self-Management Questionnaire, Diabetes Acceptance Scale, and Valued Living Questionnaire pre- and post-intervention, and at a one-month follow-up. HbA1c levels were collected at baseline and follow-up. Participants in the MBI condition experienced non-significant improvements in their well-being and diabetes acceptance over time; these changes were significantly associated post-intervention, but not at follow-up. Participants in the VGI condition experienced a non-significant pre-post improvement in their diabetes self-management, which was maintained at follow-up. Subscale analyses revealed that only the dietary control component of diabetes self-management significantly improved over time. Improvements in valued living did not reach statistical significance and no significant associations were found between changes in valued living and diabetes self-management over time. Follow-up HbA1c values were obtained for five participants, of whom four experienced clinically meaningful reductions. Study limitations included low statistical power, methodological weaknesses, and lack of control over potential confounding factors. The results, combined with participant feedback, suggest that brief online interventions may have potential in expanding access to psychological input for people with diabetes. However, further research is recommended to gain insight into their clinical benefit using more robust studies with a larger sample size and longer follow-up.
Original languageEnglish
Awarding Institution
  • Royal Holloway, University of London
  • Taylor, Dr Michelle, Supervisor, External person
  • Kingston, Jessica, Supervisor
Publication statusUnpublished - 15 Sept 2020


  • diabetes
  • acceptance
  • commitment
  • ACT
  • pilot
  • RCT
  • online

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