Last updated August 16, 2026
Key finding
Mean difference -6.2 (2.3) mmol/mol, DCCT 0.6%, p=0.038
This study evaluated the feasibility of an online cognitive-behavioral therapy program for individuals with type 1 diabetes, finding significant improvements in HbA1c and anxiety levels.
Quick read
The essential study design details in one scan.
EvidenceScore™
Moderate
Study type
RCTs
Follow-up
Long-Term (1–5 y)
Risk of bias
Some Concerns
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Plain-language summary
A plain-language read of the study’s main message and where it applies.
Study focus
This study evaluated the feasibility of an online cognitive-behavioral therapy program for individuals with type 1 diabetes, finding significant improvements in HbA1c and anxiety levels.
Improving glycemic control and reducing anxiety can enhance the overall well-being of individuals with type 1 diabetes. Effective online interventions like DOT may provide accessible mental health support, which is crucial for managing chronic conditions.
Limited to one study arm, affecting generalizability. Sample size not specified, potentially limiting statistical power. No long-term follow-up data beyond 12 months.
Published in
Publication details and source links for this paper.
Anne MD, Anne H, Arann R, Jennie B, Scott W, Khalida I. Feasibility of Online Diabetes-Focused Cognitive-Behavioral Therapy for Type 1 Diabetes. BMJ Open Diabetes Research & Care. 2021;9(1):e001934. doi:10.1136/bmjdrc-2020-001934
HbA1c levels significantly reduced by 6.2 mmol/mol (p=0.038).
Anxiety levels improved significantly with a mean difference of -3.0 (p=0.037).
No significant change in depression (p=0.14).
No significant change in diabetes distress (p=0.225).
Evidence network
Understand where this research contributes within the broader evidence network.
This study contributes evidence to Diabetes Online Therapy (DOT) and Change in anxiety scores measured by GAD-7, Depression severity measured by PHQ-9, Diabetes Distress Scale score, and 1 more.
This study contributes evidence to
Primary intervention
Diabetes Online Therapy (DOT)
Primary outcomes
Evidence topics
Primary intervention
Intervention and outcome relationships this study adds to the evidence network.
Editorial context
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Evidence network role
This section describes how the study fits into the current evidence network. It does not determine whether an intervention works on its own.
2
Related topics
4
Evidence pairs
643
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Evidence topic
Contributes evidence
Evidence topic
Contributes evidence
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Primary evidence
Evidence topic
matched_outcome
Related evidence
Evidence topic
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Core evidence
The primary outcomes reported in this study.
Diabetes Online Therapy (DOT) → Change in anxiety scores measured by GAD-7
Diabetes Online Therapy (DOT) → Change in anxiety scores measured by GAD-7
Diabetes Online Therapy (DOT) → Depression severity measured by PHQ-9
Diabetes Online Therapy (DOT) → Depression severity measured by PHQ-9
Diabetes Online Therapy (DOT) → Diabetes Distress Scale score
Diabetes Online Therapy (DOT) → Diabetes Distress Scale score
Evidence Library
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Relationships organized using the Dediabetes Evidence Intelligence™ framework.
This study contributes to evidence on Diabetes Online Therapy (DOT) and Change in anxiety scores measured by GAD-7, Diabetes Online Therapy (DOT) and Depression severity measured by PHQ-9.
This study contributes to the evidence on the following intervention-outcome relationships.
Devices & Technology
Devices & Technology
Curated evidence collections and hubs this study is part of.
All studies measuring Change in anxiety scores measured by GAD-7
Measures Change in anxiety scores measured by GAD-7 as a key outcome.
All studies measuring Depression severity measured by PHQ-9
Measures Depression severity measured by PHQ-9 as a key outcome.
All studies on Diabetes Online Therapy (DOT)
Contributes to Diabetes Online Therapy (DOT) evidence base.
Jump to pre-filtered views in Evidence Explorer.
1 results
1 results
1 results
1 results
1 results
Generated from the study's connected evidence using Evidence Intelligence™.
Diabetes Online Therapy (DOT) appears to improve change in anxiety scores measured by gad-7.
ConsistencyScore™: Consistency cannot yet be determined from the available evidence.
Ranked evidence signals
Change in anxiety scores measured by GAD-7
EvidenceScore™ Emerging | EvidenceScore™ 59.0 | strong positive | ConsistencyScore™ Unclear | 1 study
Why this answer: This answer is based on a single supporting study.
Limitations
Diabetes Online Therapy (DOT) appears to lower HbA1c.
ConsistencyScore™: Consistency cannot yet be determined from the available evidence.
Ranked evidence signals
HbA1c
EvidenceScore™ Emerging | EvidenceScore™ 59.0 | strong positive | ConsistencyScore™ Unclear | 1 study
Why this answer: This answer is based on a single supporting study.
Limitations
Current evidence does not show a clear benefit of Diabetes Online Therapy (DOT) for depression severity measured by phq-9.
ConsistencyScore™: Consistency cannot yet be determined from the available evidence.
Ranked evidence signals
Depression severity measured by PHQ-9
EvidenceScore™ Emerging | EvidenceScore™ 59.0 | neutral | ConsistencyScore™ Unclear | 1 study
Why this answer: This answer is based on a single supporting study.
Limitations
Current evidence does not show a clear benefit of Diabetes Online Therapy (DOT) for diabetes distress scale score.
ConsistencyScore™: Consistency cannot yet be determined from the available evidence.
Ranked evidence signals
Diabetes Distress Scale score
EvidenceScore™ Emerging | EvidenceScore™ 59.0 | neutral | ConsistencyScore™ Unclear | 1 study
Why this answer: This answer is based on a single supporting study.
Limitations
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