ORIGINAL ARTICLE A psychological support program for individuals with Type 1 diabetes Gabriele Forlani • Chiara Nuccitelli • Chiara Caselli • Simona Moscatiello • Arianna Mazzotti • Elena Centis • Giulio Marchesini Received: 24 December 2010 / Accepted: 30 January 2011 / Published online: 2 March 2011 Ó Springer-Verlag 2011 Abstract We aimed to test the effects of a psychological support program on the psychological distress, mood, and quality of life of well-educated individuals with type 1 diabetes. A newly developed support program was offered to 60 patients with type 1 diabetes on intensive insulin treatment, previously enrolled in group-care educational programs. Thirty-three subjects participated (experimental group, in groups of 8–12 subjects); 22, who postponed their entry, were used as controls. The program consisted of 7 weekly work sessions of 2 hours chaired by a psychol- ogist and covered aspects of daily living with diabetes using role-playing, metaplan, and problem solving. At baseline and approximately 6 months later, all participants completed a battery of questionnaires, and the differences between the experimental and the control group were analyzed by repeated-measurements ANOVA. In response to the psychological support program, subjects in the experimental group reduced their depressive mood (Beck Depression Inventory and depression scales of the Psy- chological Well-Being Index) and anxiety (Self-rating Anxiety Scale), improved disease-specific quality of life (Symptom and Well-Being scales of the Well-Being Enquiry for Diabetes), increased their internal and decreased their external locus of control. These changes were accompanied by a 0.3% decrease in glycosylated hemoglobin, whereas no significant changes were observed in the control group (ANOVA, P = 0.032). These results underline the importance of psychological aspects in indi- viduals with type 1 diabetes; treating the psychological aspects related to the disease may be as important as medical control in order to improve living with diabetes. Keywords Anxiety Á Depression Á Locus of control Á Quality of life Á Type 1 diabetes Á Well-being Introduction The role of physicians and care teams in the management of type 1 diabetes has progressively moved from pre- scribing drugs to patients’ education and support, in order to improve quality of life and psychological well-being and in turn metabolic control. The psychological distress of individuals with diabetes is high, independent of overt clinical symptoms, impacts on quality of life [1, 2] and is mediated by illness-specific cognitions and stressful events [3]. Conservative estimates report high prevalence rates of psychological distress, in particular mood and anxiety disorders: the overall preva- lence of depression is about 11%, and the lifetime preva- lence of major depressive disorders varies between 24 and 30% [4–6], i.e., twice as high when compared with the population without diabetes, after controlling for age and sex [5]. The prevalence rates of depression are particularly high in young male subjects [7], in the presence of chronic complications [1, 3, 8] and frequent hypoglycemic epi- sodes [9], and in relation to low socioeconomic status [10]. Depression is also associated with poorer metabolic control and increased risk of future complications [9], and a similar association has been recently reported in a large The psychological support program described in this article received the Italian DAWN award 2010 ‘‘Premio Roberto Sivieri’’, supported by Novo Nordisk. G. Forlani Á C. Nuccitelli Á C. Caselli Á S. Moscatiello Á A. Mazzotti Á E. Centis Á G. Marchesini (&) Unit of Metabolic Diseases and Clinical Dietetics, ‘‘Alma Mater Studiorum’’ University, S. Orsola-Malpighi Hospital, Via Massarenti, 9, I-40138 Bologna, Italy e-mail: giulio.marchesini@unibo.it 123 Acta Diabetol (2013) 50:209–216 DOI 10.1007/s00592-011-0269-x