Summary: In 429 adults with type 1 or type 2 diabetes and mild-to-moderate diabetes distress, a telehealth problem-solving therapy programme (LISTEN, maximum four sessions) reduced diabetes distress at 26 weeks versus usual web-based resources (PAID mean difference -7.2; 95% CI -11.6 to -2.8; P<0.001). The benefit was statistically clear but the effect size was small (Cohen f2 = 0.03), and no adverse events were reported.
PICO Summary
| Element | Detail |
|---|---|
| Population | 429 adults with diabetes distress (PAID score ≥25, or ≥2 on three or more items); 37% type 1 and 63% type 2 diabetes; median age 54; 59% women. Recruited via a national diabetes services scheme. Two-arm, parallel-group, pragmatic randomised controlled trial (1:1), analysed by intention to treat. Single-country (Australia). |
| Intervention | LISTEN: low-intensity mental health support delivered via a telehealth-enabled network, comprising a maximum of four sessions of problem-solving therapy facilitated by diabetes health professionals (n=216). |
| Comparison | Usual care: web-based resources about diabetes and emotional health (n=213). |
| Outcome | Primary outcome (change in diabetes distress, PAID, baseline to 26 weeks): greater reduction with LISTEN, mean difference -7.2 (95% CI -11.6 to -2.8; P<0.001; Cohen f2 = 0.03, a small effect). Secondary outcomes: greater improvements in general emotional well-being and coping self-efficacy. No adverse events reported. No mortality, glycaemic, or longer-term durability outcomes reported beyond 26 weeks. |
LISTEN telehealth therapy for diabetes distress
Pragmatic RCT · type 1 & 2 diabetes · 26 weeks
Brief telehealth problem-solving therapy cut diabetes distress more than web resources at 26 weeks. The difference was statistically clear but small, and durability beyond six months is unknown.
Expert Commentary
This pragmatic randomised trial provides reasonable evidence that a brief, telehealth-delivered, problem-solving therapy programme can reduce diabetes distress more than passively provided web resources. The verdict is positive but measured: the between-group difference of 7.2 points on the PAID scale was statistically robust and reached the threshold often regarded as clinically meaningful, yet the accompanying effect size was small (Cohen f2 = 0.03), so the average individual gain over usual care should be framed modestly rather than as a transformative result. The main limitation to weigh is the unblinded, open-label design inherent to a behavioural intervention compared against a low-engagement control, which can inflate self-reported psychosocial outcomes through expectation effects; durability was also assessed only to 26 weeks, leaving longer-term maintenance unknown. The comparator was deliberately minimal, so the contrast reflects active support versus little support rather than against an alternative therapy. Can I use this with my patients? Plausibly yes, for motivated adults with mild-to-moderate diabetes distress who can access and engage with telehealth, as an adjunct rather than a replacement for clinical care. Clinicians should consider how to embed brief structured psychological support into routine diabetes services and confirm whether these gains persist beyond six months.
References
Holloway EE, Jenkins L, Agius PA, et al. Effectiveness of Low Intensity Mental Health Support via a Telehealth Enabled Network (LISTEN) for Adults With Diabetes Distress: A Parallel Group, Pragmatic Randomized Controlled Trial. Diabetes Care. 2025;48(6):955-965. doi:10.2337/dc24-2525
