# Evaluating Affective and Unified Behavioral Approaches to Reducing Diabetes Distress and Improving Glycemic Control

> **NIH NIH R01** · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · 2021 · $636,467

## Abstract

PROJECT SUMMARY/ABSTRACT
Diabetes distress (DD) refers to the often hidden emotional burdens, stresses, and worries that result from
managing a demanding, progressive, and chronic disease like type 1 diabetes (T1D). DD is highly prevalent,
with approximately 42% of T1D adults manifesting elevated DD; is distinct from clinical depression; tends to be
chronic, rather than episodic; and has been significantly associated with poor glycemic control and problematic
self-care behavior. Systematic reviews suggest the development of effective interventions for DD have been
impeded by: the majority of interventions not targeting DD directly, instead delivering various forms of diabetes
education and disease-management, few studies being grounded in a theoretical framework that drives an
intervention strategy; study designs that rarely allow for direct comparison of different approaches to reduce
DD; relatively few studies focused on T1D, and no study to date that has explored different approaches to DD
reduction in ways that directly maximize improvements in glycemic control. To address these problems we
propose a 3-arm clinical trial with T1D adults that uses theoretically supported, evidenced-based interventions
to test the added value of a program that targets DD directly through emotion regulation strategies (TunedIn)
and a unified DD and disease management intervention (FixIt) to reduce DD and improve glycemic control,
relative to a traditional education/disease management intervention (StreamLine). The primary outcome is
HbA1c. We will explore mediating pathways linking changes in DD with changes in HbA1c over time. The
effect of selective moderating variables on intervention effectiveness will be assessed. Intervention costs and
stakeholder input will inform dissemination and future program implementation.

## Key facts

- **NIH application ID:** 10135938
- **Project number:** 5R01DK121241-03
- **Recipient organization:** UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
- **Principal Investigator:** LAWRENCE FISHER
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $636,467
- **Award type:** 5
- **Project period:** 2019-04-01 → 2023-03-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10135938

## Citation

> US National Institutes of Health, RePORTER application 10135938, Evaluating Affective and Unified Behavioral Approaches to Reducing Diabetes Distress and Improving Glycemic Control (5R01DK121241-03). Retrieved via AI Analytics 2026-05-25 from https://api.ai-analytics.org/grant/nih/10135938. Licensed CC0.

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