Primary and secondary outcomes
anxiety, ’, depressive, depressive symptoms, depression, T2DM, diabetes distress, diabetes
DISEASE, DIABETES
We found a significant mean difference between EXP and WLC conditions in post-testing scores on PHQ which indicates CBT substantially decreased depressive symptoms among patients with T2DM. Findings indicate that significant mean differences were found between EXP and WLC groups on SHAI which indicates that the CBT played a 77% role in reducing the level of health anxiety in the experimental group. Furthermore, significant mean differences were found between baseline and post-testing scores on the scale of EBS, PDS, RDS, IDS and overall DDS between EXP and WLC which indicates CBT reduced 63% emotional burden, 68% physician burden, 66% of regimen distress, 53% of interpersonal distress and 76% of overall diabetes distress of EXP group. Similarly, EXP group was found to be significantly different as compared to WLC on PBNA, ADPB, CRNA and overall GMAS which shows that CBT also improved adherence to treatment; such as: 48% patient behavior related non-adherence, 42% additional disease and pill burden describe non-adherence, 51% cost related non adherence and 57% over all general medication adherence to treatment. Analysis reveals a significant difference between EXP and WLC after CBT on SATS, IMPS, WORS, and overall DQLS which shows CBT sessions improved satisfaction to the degree of 41%, impact to the degree of 43%, non-worried behavior to the degree of 41%, and, overall diabetes patients’ quality of life to the degree of 58%. Furthermore, findings show that CBT produced a significant difference in changing lifestyle as compared to WLC on WALS, MPAS, VPAS and IPAQ which shows that patients with T2DM improved their quality of life after getting CBT sessions; such as: walking activities to the degree of 69%, moderate physical activities to the degree of 23%, vigorous physical activities to the degree of 33%, and overall daily physical activities to the degree of 73% (see Table Mean (standard deviation) and repeated-measure ANOVA of clinical scores during pre- and post-test interventionsNote: *** = The analysis reveals that scores significantly decreased throughout the treatment among the experimental group on PHQ, HAI, and DDS, and the group’s scores enhanced on MAS. CBT played an influential role in addressing depressive symptoms, health-related anxiety, and diabetes distress. On the other hand, CBT played a supportive role in increasing treatment adherence (see Fig. Symptomatic change in PHQ, HAI, DDS and MAS scores over the course of treatment between experimental and waitlist control groups. Findings showed a significant improvement in symptoms of depression in the EXP group. The score in the pre-vs. post of the EXP group is as follows: minimal depressive symptoms 0% vs. 3.7%, mild depressive symptoms 7.4% vs.37.1%, moderate depressive symptoms 40.8% vs. 59.3%; this indicates that CBT significantly reduced depressive symptoms. Similarly, at pre-assessment, the moderate-severe depressive symptoms were in 33.4% of the participants, and severe depressive symptoms were in 18.5% of the participants which got reduced due to CBT at post-assessment, while no significant change was observed in the waitlist control group (see Table Range of symptoms severity on Patients Health Questionnaire (PHQ) between experimental and waitlist control groups at pre-and post-assessment scoresFindings show that CBT significantly improved adherence to treatment among individuals with T2DM. Post-testing analysis reveals that the individuals from the EXP group got an improvement in their treatment adherence considerably. For example, high adherence, which was at 2(7.41%) at baseline, increased 10(37.04%), good adherence, which was at 3(11.12%) at baseline, improved to 12(44.45%), partial adherence, which was at 13(46.15%) at the baseline, shrank to 3(11.12%) as people moved to higher categories, and, low adherence, which was at 6(22.23%) at baseline, again shrank to 2(7.41%) as people moved to higher categories. In the case of WLC, no significant difference was observed, such as, high adherence at baseline had 3(8.57%) participants and at post-analysis stage there were 2(5.71%); good adherence at baseline had 6(17.14%) participants and at post-analysis stage there were 5(14.29%); partial adherence at baseline had 15(42.86%) participants and at post-analysis stage there were 18(51.43%); low adherence at baseline had 9(25.71%) participants and at post-analysis stage there were 6(17.14%); whereas, poor adherence at baseline had 2(5.71%) participants and at post-analysis stage there were 4(11.43%) (see Table Score difference on General Medical Adherence Scale (GMAS) between experimental and waitlist control groups at pre-and post-assessment scores