Diabetes distress (DD) refers to the unique emotional burdens, worries and concerns that are part of the spectrum of patient experience when managing a severe, demanding chronic disease like diabetes. High DD is very common and persistent over time among those with diabetes, and it has been significantly associated with poor glycemic control, poor self-care, low diabetes self-efficacy, and poor quality of life, even after controlling for clinical depression. The vast majority of research in DD has focused on adults with type 2 diabetes, a metabolic disease based on genetic predisposition, obesity, sedentary lifestyle and insulin resistance. Far less research has focused on the very different experiences of DD among adults with type 1 diabetes: an autoimmune disease that requires much more intensive and intrusive management than type 2. The proposed research addresses two major gaps in the clinical care of adult patients with type 1 diabetes and DD: to develop a practical, reliable and valid measure of DD for adult patients with type 1 diabetes, with empirically defined cut- points for high DD;and to test a unique, pragmatic, theory based program to reduce high DD among at-risk, poorly controlled type 1 adults. Following a brief measurement study to establish reliable cut-points for high DD, we propose a 2-arm clinical trial to test the comparative effectiveness of an adaptation of Problem Solving Therapy, which now includes a comprehensive focus on emotion, behavior and cognition, with a current standard of care - enhanced diabetes education. Primary outcomes are reduced DD and improved glycemic control. The innovative intervention uses a variety of modalities, some based on electronic and social media (e.g., real time web-based group calls, web-based blogging, personal telephone contact) to enhance participation and retention, and reduce patient burden. We will also assess the impact of selective mediating and moderating variables, collect measures of cost, and will link the findings to dissemination and implementation using RE-AIM.

Public Health Relevance

The proposed project will develop and test an intervention to reduce high DD among adults with type 1 diabetes. In contrast to the educational and narrow cognitive frameworks currently in use, this already piloted, innovative, evidenced-based program is practical, generalizable and patient-sensitive, resulting in a substantive public health impact.

National Institute of Health (NIH)
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Research Project (R01)
Project #
Application #
Study Section
Behavioral Medicine, Interventions and Outcomes Study Section (BMIO)
Program Officer
Hunter, Christine
Project Start
Project End
Budget Start
Budget End
Support Year
Fiscal Year
Total Cost
Indirect Cost
University of California San Francisco
Family Medicine
Schools of Medicine
San Francisco
United States
Zip Code
Fisher, Lawrence; Hessler, Danielle; Polonsky, William et al. (2018) Emotion regulation contributes to the development of diabetes distress among adults with type 1 diabetes. Patient Educ Couns 101:124-131
Fisher, Lawrence; Hessler, Danielle; Polonsky, William H et al. (2018) T1-REDEEM: A Randomized Controlled Trial to Reduce Diabetes Distress Among Adults With Type 1 Diabetes. Diabetes Care 41:1862-1869
Hessler, D M; Fisher, L; Polonsky, W H et al. (2017) Diabetes distress is linked with worsening diabetes management over time in adults with Type 1 diabetes. Diabet Med 34:1228-1234
Fisher, L; Polonsky, W H; Hessler, D et al. (2017) A practical framework for encouraging and supporting positive behaviour change in diabetes. Diabet Med 34:1658-1666
Fisher, Lawrence; Hessler, Danielle; Polonsky, William et al. (2016) Diabetes distress in adults with type 1 diabetes: Prevalence, incidence and change over time. J Diabetes Complications 30:1123-8
Fisher, Lawrence; Polonsky, William H; Hessler, Danielle M et al. (2015) Understanding the sources of diabetes distress in adults with type 1 diabetes. J Diabetes Complications 29:572-7
Fisher, L; Gonzalez, J S; Polonsky, W H (2014) The confusing tale of depression and distress in patients with diabetes: a call for greater clarity and precision. Diabet Med 31:764-72