Marilyn Ritholz

Joslin Diabetes Center · Section on Behavioral and Mental Health

Introduction Depression can exacerbate diabetes by impairing self-care behaviors and increasing the risk of complication; however, the underlying mechanism is still unclear. Given the suggested associations between walking activity, depression status, and blood glucose levels this study explores the intricate relationship between depression and blo...

Bioethics conjures images of dramatic healthcare challenges, yet everyday clinical ethics issues unfold regularly. Without sufficient ethical awareness and a relevant working skillset, clinicians can feel ill-equipped to respond to the ethical dimensions of everyday care. Bioethicists were interviewed to identify the essential skills associated wit...

Background The management of type 2 diabetes (T2D) and obesity, particularly in the context of self-monitoring, remains a critical challenge in health care. As nearly 80% to 90% of patients with T2D have overweight or obesity, there is a compelling need for interventions that can effectively manage both conditions simultaneously. One of the goals i...

This qualitative study examined adults’ recollections of their reactions to their diabetes diagnosis and explored the similarities and differences among those diagnosed with type 1 versus type 2 diabetes. Based on semistructured interviews, the authors identified three themes: 1) shared emotional reactions of fear, sadness, confusion, and worry; 2)...

BACKGROUND The management of type 2 diabetes (T2D) and obesity, particularly in the context of self-monitoring, remains a critical challenge in health care. As nearly 80% to 90% of patients with T2D have overweight or obesity, there is a compelling need for interventions that can effectively manage both conditions simultaneously. One of the goals i...

Background Depression and anxiety are the main sources of work and social disabilities as well as health-related problems around the world. Digital therapeutic solutions using cognitive behavioral therapy have demonstrated efficacy in depression and anxiety. A common goal of digital health apps is to increase user digital engagement to improve outc...

Background Stress is an emotional response caused by external triggers and is a high-prevalence global problem affecting mental and physical health. Several different digital therapeutic solutions are effective for stress management. However, there is limited understanding of the association between relaxation components and stress levels when usin...

BACKGROUND Stress is an emotional response caused by external triggers and is a high-prevalence global problem affecting mental and physical health. Several different digital therapeutic solutions are effective for stress management. However, there is limited understanding of the association between relaxation components and stress levels when usin...

BACKGROUND Depression and anxiety are the main sources of work and social disabilities as well as health-related problems around the world. Digital therapeutic solutions using cognitive behavioral therapy have demonstrated efficacy in depression and anxiety. A common goal of digital health apps is to increase user digital engagement to improve outc...

Background The detrimental effects of weight stigma are a growing concern as a contributor to negative physical and mental health outcomes, disparities in care, and healthcare avoidance. Research exploring the impact of weight-neutral healthcare is limited but suggests weight-neutral interventions are associated with positive psychological and beha...

Significant racial/ethnic disparities in healthcare and diabetes technology use have been observed in Type 2 diabetes mellitus (T2DM), which are associated with nonengagement in diabetes self-management and out-of-range glycemia. This study aimed to assess whether there were differences in the blood glucose levels achieved by several racial/ethnic...

Background The overlap in prevalence between type 2 diabetes and binge eating disorder is substantial, with adverse physical and mental health consequences. Little is known about patients’ efforts at managing these two conditions simultaneously. The research objective was to explore patients’ experiences managing co-existing type 2 diabetes or pred...

Aims: To explore the lived experiences of diabetes distress (DD) in adults with type 1 and type 2 diabetes, and to identify similarities and differences in these experiences. Methods: We conducted in-depth interviews with people with type 1 (n = 19) and type 2 diabetes (n = 29). We conducted thematic analysis using NVivo 12 software. Results:...

Introduction: As the prevalence of type 2 diabetes (T2D) continues to grow worldwide, individuals struggle with how to integrate diabetes self-management into their lives. This is complicated by the high rate of depression and stress among persons with T2D. A multicondition behavior change-oriented digital therapeutic platform may alleviate the bur...

Aim: Although binge-eating disorder (BED) is a common comorbidity of type 2 diabetes, little is known about the treatment experiences for persons with both conditions. Our aim was to explore perceptions of Primary Care Providers' (PCPs') treatment among adult women with both diagnoses. Methods: In this qualitative descriptive study, we conducted...

Aims A multidisciplinary team of clinicians and researchers, patients and family members, and representative from national advocacy groups and research organization met to review the literature, highlight gaps, and identify best practices to improve adult care delivery for young adults (YA) with diabetes. Methods The participants prepared presenta...

Background Remote data capture for blood glucose (BG) or blood pressure (BP) monitoring and the use of a supportive digital app are becoming the model in diabetes and hypertension chronic care. One of the goals in chronic condition management is to increase awareness and generate behavioral change in order to improve outcomes in diabetes and relate...

Background The overlap in prevalence between type 2 diabetes (T2DM) and binge eating disorder (BED) is substantial, with adverse physical and mental health consequences. Little is known about patients’ efforts at managing these two conditions simultaneously. The research objective was to explore patients’ experiences managing co-existing T2DM/predi...

BACKGROUND Remote data capture for blood glucose (BG) or blood pressure (BP) monitoring and the use of a supportive digital app are becoming the model in diabetes and hypertension chronic care. One of the goals in chronic condition management is to increase awareness and generate behavioral change in order to improve outcomes in diabetes and relate...

Background Social support may buffer or decrease the negative effects of diabetes distress (DD) and depressive symptoms on diabetes outcomes. We assessed the buffering role of social support in the relationship between DD and self‐care and depressive symptoms and self‐care in adults with Type 1 (T1D) and Type 2 (T2D) diabetes. Methods Participants...

Background: Social support is associated with better physical and mental health in people with diabetes. Social support may buffer the negative effects of diabetes distress on health outcomes. The purpose of this study was to assess the moderating role of social support in the relationship between diabetes distress and self-care in adults with type...

Background Southeastern Appalachian Ohio has more than double the national average of diabetes and a critical shortage of healthcare providers. Paradoxically, there is limited research focused on primary care providers’ experiences treating people with diabetes in this region. This study explored providers’ perceived barriers to and facilitators fo...

Background: Adults with type 1 diabetes (PWDs) face challenging self-management regimens including monitoring their glucose values multiple times a day to assist with achieving glycemic targets and reduce the risk of long-term diabetes complications. Recent advances in diabetes technology have reportedly improved glycemia, but little is known abou...

Abstract Background Hypoglycemia is a severe clinical problem with physical and psychosocial implications for people with type 1 and type 2 diabetes. Medical students would benefit from formal education on how to treat hypoglycemia as well as how to administer glucagon in case of a severe hypoglycemic emergency. The purpose of this study was to ass...

BACKGROUND Adults with type 1 diabetes (PWDs) face challenging self-management regimens including monitoring their glucose values multiple times a day to assist with achieving glycemic targets and reduce the risk of long-term diabetes complications. Recent advances in diabetes technology have reportedly improved glycemia, but little is known about...

Little is known about how adults with type 1 diabetes (T1D) engage with technology to make positive changes in diabetes self-management. We explored the qualitative experiences of T1D adults after a clinical intervention that included FreeStyle Libre (FSL) linked to “Sugar Sleuth,” a mobile-based system that prompted patients to reflect on the caus...

Purpose: Food and eating convey memories and feelings and serve important functions in creating and maintaining relationships. Given the increasing rate of diabetes in the United States, research understanding the meaning of food may shed light on how patients negotiate everyday food choices while managing type 2 diabetes. The purpose of this qual...

Aims To investigate the experiences among adults with diabetes of discussions of microvascular complications and provide recommendations for providers. Methods We performed a qualitative study in 148 adults with Type 1 and Type 2 diabetes (56% women, 95% white, mean age 60±13 years, 65% with Type 1 diabetes, 71% with ≥1 microvascular complication)...

The prevalence of diabetes is increasing in older populations worldwide. Older adults with diabetes have unique psychosocial and medical challenges that impact self-care and glycemic control. These challenges may include psychological factors such as depression or anxiety, social factors such loss of independence and removal from home environment/p...

Objective This qualitative study aimed to explore the experience of transition from pediatric to adult diabetes care reported by posttransition emerging adults with type 1 diabetes (T1D), with a focus on preparation for the actual transfer in care. Methods Twenty-six T1D emerging adults (mean age 26.2±2.5 years) receiving adult diabetes care at a...

OBJECTIVE Diabetes self-care is challenging and requires effective patient-provider communication to achieve optimal treatment outcomes. This study explored perceptions of barriers and facilitators to diabetes self-care communication during medical appointments.DesignQualitative study using in-depth interviews with a semistructured interview guide....

PurposeThe purpose of this study was to explore perceptions that emerging adults with type 1 diabetes (T1D) have of their patient-provider relationships across the transition from pediatric to adult care.Methods Twenty-six emerging adults with T1D (mean age 26.2 ± 2.5 years) participated in 5 focus groups stratified by current level of glycemic con...

To examine the impact of continuous glucose monitoring on diabetes management and marital relationships of adults with Type 1 diabetes and their spouses. Nine younger (30-49 years) and 11 older (50-70 years) patients with Type 1 diabetes and 14 spouses participated in eight focus groups specific to age and role (patient or spouse). Audio-recorded d...

Diabetes has become a global pandemic and Chinese Americans are at least 60% more likely to develop type 2 diabetes than White Americans, despite having lower body weight, due to a combination of genetic and environmental factors. Because of the increased risk, it is vitally important to address the issues of treatment adherence and diabetes self-m...

Nearly one-half of diabetic patients have glycated hemoglobin A(1c) (HbA(1c)) levels above recommended targets. Effective physician-patient communication improves glycemia and diabetes self-care; however, communication gaps may exist that prevent patients from discussing self-care problems with treatment providers. We assessed diabetic patients' (n...

Despite new treatment therapies and the emphasis on patient activation, nearly 50 % of diabetes patients have hemoglobin A(1c) levels above target. Understanding the impact of unmet treatment goals on the physician-patient relationship is important for maintaining quality care in clinical practice. To explore physicians' and type 2 diabetes patient...

The purpose of this study was to explore physicians' perceptions of the multidisciplinary type 2 diabetes treatment team. Nineteen physicians (74% endocrinologists; 26% primary care) participated in semistructured interviews. Audiorecorded data were transcribed, coded, and analyzed using thematic analysis and NVivo 8 software. Physicians considered...

Qualitative research methodology is more recognized and valued in diabetes behavioral research in recent years. Qualitative methods help clinicians answer questions that quantitative research may not be able to answer, such as exploring patients' motivations, perceptions, and expectations. This paper reviews recent (2005-present) rigorous qualitati...

The purpose of this study was to explore perceptions of psychosocial adaptations in parenting young children with type 1 diabetes (T1DM) from diagnosis through childhood. Fourteen parents of 11 children with T1DM who were diagnosed at age five years or younger participated in semi-structured interviews. Data were analyzed using content analysis. Th...

To explore physicians' awareness of and responses to type 2 diabetic patients' social and emotional difficulties. We conducted semistructured interviews with 19 physicians. Interviews were transcribed, coded, and analyzed using thematic analysis. Three themes emerged: 1) physicians' awareness of patients' social and emotional difficulties: physicia...

To identify psychosocial factors associated with the use of continuous glucose monitoring by adults with Type 1 diabetes. Twenty adult patients (aged 45 +/- 15 years, diabetes duration 25 +/- 19 years, 50% female) followed at our site in the multi-centre Juvenile Diabetes Research Foundation continuous glucose monitoring trial were divided into thr...

Patients in diabetes treatment sometimes struggle with psychosocial problems that may interact with their abilities to manage diabetes. Health care providers may feel frustrated, ineffective, and helpless because it is difficult to form a working alliance with these challenging patients. This chapter defines the working alliance and presents it as...

As biotechnological devices become a more expected part of everyday diabetes management, consideration of psychosocial factors in the use of these devices is of growing importance. Continuous glucose monitoring (CGM) is the newest technology. However, little is known about how and which patients can most effectively use CGM devices. CGM is a real-t...

The purpose of this study was to identify psychosocial issues related to diabetes, approaches to self-care, self-perceptions, and social interactions among insulin pump users with type 1 diabetes. Adult insulin pump users participated in focus groups loosely formed on the basis of A1C level. Transcripts of focus group meetings were coded into theme...

Despite recognition that dying children and their families have unique palliative care needs, there has been little empirical inquiry of parent perspectives to improve the quality of end-of-life care and communication. The purpose of this study was to identify and describe the priorities and recommendations for end-of-life care and communication fr...

OBJECTIVE. Despite recognition that dying children and their families have unique palliative care needs, there has been little empirical inquiry of parent perspectives to improve the quality of end-of-life care and communication. The purpose of this study was to identify and describe the priorities and recommendations for end-of-life care and commu...

To increase understanding of adolescent-parent diabetes-related conflicts and supports in the management of type 1 diabetes by means of a focus group research approach. Twenty-four adolescents (10 boys and 14 girls, age 13-15 years; 97% white) participated in three same-sex focus groups at two diabetes summer camps. The focus group leader used a pr...

To increase understanding of the everyday experiences of hypoglycemia for patients with type 1 diabetes through the use of a narrative research approach. Center for diabetes treatment and research. Cross-sectional assessment using a narrative research approach. Twenty outpatients (aged 21-30 years) diagnosed with type 1 diabetes for at least 10 yea...

After inpatient treatment focused on aberrant eating behavior, six depressed normal-weight bulimic patients showed little improvement in depressive or eating symptoms. Four depressed anorexic patients with bulimic behavior improved in both areas, and five restricting anorexic patients had an intermediate response.

Thirty normal-weight female bulimics were followed up 2-5 years following hospital admission using semistructured interviews and psychometric measures. Inasmuch as bulimia was only recently designated a distinct disorder, questions have emerged with regard to its clinical course and diagnostic validity. Results of this investigation suggest that bu...

Previous research has indicated a strong association between bulimia and affective disorder at the time of initial clinical assessment. To investigate this relationship from a long-term perspective, 30 normal weight female bulimics were evaluated 2 to 5 years posthospital admission with psychometric measures and clinical interviews. Contrary to pre...

Randomly assigned 24 persons at high risk for suicide to a special group therapy program designed for depressed and suicidal persons. Descriptive data were gathered on all clients and 7 of the 24 Ss were followed intensively. Outcome variables were assessed in 3 sets: case fatality rates, client ratings of 3 self-report scales, and 3 therapists' ra...

Typescript. Thesis (Ph. D.)--University of Wisconsin--Madison, 1986. Vita. Includes bibliographical references (leaves 151-163).