Effect of Cognitive-behavioral Training Combined with Motivational Interviewing on Treatment Adherence and Hemoglobin A1c in Patients with Diabetes and Depressive Symptoms

Abstract

Background: Depression associated with diabetes increases the possibility of non-adherence to care and treatment programs. The use of psychological approaches can improve patients’ self-management ability. Objectives: This study aimed to examine the effect of cognitive-behavioral training combined with motivational interviewing on treatment adherence and hemoglobin A1c (HbA1c) in patients with diabetes and depressive symptoms. Methods: This randomized clinical trial was performed on two groups of 45 patients (n = 90) with type 2 diabetes and depression in a diabetes clinic affiliated with a teaching hospital in Iran in 2021. The participants were selected using convenience sampling and randomly divided into two intervention groups. The patients in the cognitive-behavioral intervention group with motivational interviewing attended eight face-to-face training sessions three times a week, and the patients in the cognitive-behavioral group attended only four cognitive-behavioral training sessions two times a week. Twelve weeks after the intervention, the personal information and HbA1c levels reported by the laboratory were collected using an information form. Other data were collected using the Morisky Medication Adherence Scale. The collected data were analyzed with SPSS software (version 22) using paired samples t-test, independent samples t-test, chi-square test, and analysis of covariance (ANCOVA). Results: The results of ANCOVA showed that the mean score of medication adherence of the patients in the cognitive-behavioral group with motivational interviewing after receiving the intervention (5.54 ± 1.05) was significantly higher than the medication adherence score of the patients in the cognitive-behavioral training group (4.87 ± 1.01) (P = 0.002). Moreover, the mean HbA1 level of patients in the group receiving cognitive-behavioral training combined with motivational interviewing (8.42 ± 0.69) was significantly lower than the corresponding value for patients in the cognitive-behavioral training group (9.47 ± 1.28) (P = 0.001). Conclusions: Cognitive-behavioral training combined with motivational interviewing had a greater effect than cognitive-behavioral training alone on increasing medication adherence and reducing HbA1c levels in patients with diabetes and depression. Thus, motivational approaches can be incorporated into routine psychological training to better manage diabetes and depression symptoms.