New results from a USC-led research study demonstrate the value of occupational therapy for improving the health and quality of life of young adults living with diabetes.

Research participants who completed the Resilient, Empowered, Active Living with Diabetes program—an occupational therapy intervention focusing on the lifestyle-related activities, habits, and goals of young adults who are managing their diabetes—significantly improved their average blood glucose levels, diabetes-related quality of life, and habits for checking blood glucose.

Results of the randomized, controlled trial led by principal investigator Elizabeth Pyatak, an assistant professor at the USC Mrs. T.H. Chan Division of Occupational Science and Occupational Therapy, were made available online ahead of print by Diabetes Care on Jan. 19.

The publication is the first occupational therapy clinical trial to appear in any diabetes-focused literature or journal. Diabetes Care is among the most respected and rigorous journals on the topic.

The needs of young adults

Pyatak and her colleagues aimed to rigorously test the effectiveness of the REAL Diabetes program, an activity-based intervention designed by Pyatak to address the needs of young adults from low socioeconomic status or racial/ethnic minority backgrounds who are diagnosed with type 1 or type 2 diabetes.

Young adulthood poses distinct challenges related to health-care access and the successful management of chronic diseases. Those challenges are further magnified by limited finances, greater stress, and more barriers to quality care, all of which are more common among individuals with low-socioeconomic status or from under-represented minority backgrounds.

At the heart of REAL Diabetes is a manual that guides the occupational therapist and participant together through seven modules that each include suggested goals, activities supporting those goals, and relevant educational materials and resources. The module topics are assessment and goal-setting; living with diabetes; access and advocacy; activity and health; social support; emotions and well-being; and long-term health.

Research participants included English- and Spanish-speaking young adults, ages 18-30 years and living in Los Angeles County, who have a diabetes diagnosis and low-socioeconomic status.

Participants were randomly assigned to either of two groups: Forty-one participants were assigned to receive the REAL Diabetes intervention with a licensed occupational therapist for a minimum of 10 hours over the course of 6 months, whereas 40 participants were assigned to a control group that consisted of an initial home visit at which they received a packet of educational materials and 11 follow-up telephone conversations guided by a script.

Improved hemoglobin, quality of life, habits

Participants who completed the program showed significant improvements in their hemoglobin A1c levels as tested by the Alere Afinion HbA1c blood assay; in their diabetes-related quality of life as measured by the Audit of Diabetes Dependent Quality of Life; and in the strength of their habits for self-monitoring blood glucose as evaluated by the Self-Reported Behavioral Automaticity Index.

Although the study was not large enough to statistically evaluate the underlying mechanisms that make REAL Diabetes effective, the researchers hypothesize that by building healthier habits and routines—a central focus of occupational therapy in chronic disease management—participants can improve and sustain their health and quality of life.

“Occupational therapists are the experts of choice when it comes to the intersection of everyday activities, lifestyle, and better management of chronic diseases,” said Pyatak, who is both a researcher and occupational therapist. “The REAL Diabetes study validates our distinct contributions on every diabetes care team and shows the real differences that occupational therapy can make in the lives of the 30 million Americans who have diabetes.”