Primed for Precision: A Review of the Evidence for Heterogeneous Treatment Effects in Diabetes Distress Treatments Among Adults with Type 1 Diabetes and Recommendations for Future Research.

PURPOSE OF REVIEW: Care guidelines recommend screening and intervention for diabetes distress (DD) as part of standard type 1 diabetes (T1D) care. The variability in how individuals with diabetes experience distress, alongside the range of treatment options, underscores the value of tailoring approaches for addressing diabetes distress. Our objective was to summarize contemporary clinical trials addressing DD directly in adults with T1D, focusing on evidence of heterogenous treatment effects. RECENT FINDINGS: We reviewed five studies testing diverse intervention strategies, including emotional support, telehealth, digital health platforms, and patient-centered communication. All studies were effective in reducing DD. Four studies examined the variation in treatment effects or outcomes in relation to observable participant characteristics and demonstrated heterogeneity both in the factors associated with changes in DD and factors associated with the differential impact of specific interventions. This review uncovered preliminary evidence of heterogeneous treatment effects across a range of DD-focused interventions. Gaining a deeper, more comprehensive understanding of the individuals or subgroups for whom evidence-based DD strategies are particularly effective versus less effective is needed to advance data-driven personalized treatment for DD. Future studies should prioritize diversity in enrolled individuals and advanced analytic approaches that can empirically match individuals with elevated DD to their optimal treatment approach.

Duke Scholars

Author Nikki Freeman Biostatistics & Bioinformatics, Division of Biostatistics