Behavioural Science in Diabetes: Contributions and Opportunities

Indiana University-Purdue University Indianapolis, Indianapolis, Indiana, United States
Diabetes Care (Impact Factor: 8.42). 06/1999; 22(5):832-43. DOI: 10.2337/diacare.22.5.832
Source: PubMed


To summarize the current status of behavioral research and practice in diabetes and to identify promising future directions.
We review behavioral science contributions to diabetes in self-management and patient empowerment, interventions with children and adolescents, and special problems including blood glucose awareness training and complications such as depression. We also identify emerging areas in which behavioral science stands to make significant contributions, including quality of life, worksite and community programs, interventions using new information technologies, and translation research evaluating practical programs in representative settings. We then discuss the gap between the generally encouraging research on behavioral contributions to diabetes and the infrequent incorporation of such contributions in practice. Suggestions are made for how to close this gap, including ways to increase understanding of behavioral issues, opportunities for funding of key research and implementation questions, and how behavioral science principles can become more integrated into diabetes organizations and care.
Changes are required on the part of behavioral scientists in how they organize and present their research and on the part of potential users of this knowledge, including other health professions, organizations, and funding agencies. Integrating behavioral science advances with other promising genetic, medical, nutritional, technology, health care, and policy opportunities promises not only to broaden our understanding of diabetes but also to improve patient care, quality of life, and public health for persons with diabetes.

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Available from: Edwin B Fisher
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    • "Type 1 diabetes is a chronic illness requiring an intensive and challenging self-management regimen. This includes daily insulin injections, frequent blood glucose tests, close monitoring of food intake, and regular exercise [1]. Compared to younger children and adults with diabetes, adolescents with diabetes have been found to show poorer self-management behaviours [2] and poorer metabolic control [3] [4]. "
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    ABSTRACT: Self-management of diabetes is challenging, especially for adolescents who face multiple changes, including closer peer relationships. Few studies have explored how friends can provide constructive support in this effort. The present research investigated, in two qualitative studies, the perceptions of adolescents with diabetes and their friends with respect to the positive social support that friends can offer. In study 1, 28 adolescents aged 12-15 with type 1 diabetes participated in online focus groups. In study 2, 11 of these adolescents were interviewed in person together with their best friends. The data were analysed by means of content analysis. In study 1, the adolescents with diabetes identified various supportive behaviours of friends, particularly concerning emotional support: treating them normally, showing interest, having fun, providing a distraction, and taking their diabetes into account. They differed in their attitude towards support, and this influenced which behaviours they perceived as supportive. Study 2 showed that the adolescents with diabetes and their friends often had similar opinions on the desired degree of support. Fear of stigmatization and sense of autonomy withheld some adolescents with diabetes from soliciting more support. These insights can be useful in patient education aiming to promote social support.
    Full-text · Article · Jan 2014
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    • "Type 1 diabetes is a long-term, chronic condition with incidence rates increasing at approximately 3% per year in countries around the world [1,2]. People with type 1 diabetes depend on regular insulin injections and must adhere to multiple self-care tasks to optimize glycaemic control; however, many patients struggle to self-manage their diabetes effectively [3,4]. If not managed properly, type 1 diabetes can lead to increased risk of premature death, can have potentially devastating consequences for patients’ health and quality of life, and can affect the quality of life of family members [5-8]. "
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    ABSTRACT: Background Structured education programmes for patients with diabetes and other chronic conditions are being widely adopted. However, follow-up studies suggest that course graduates may struggle to sustain the self-care practices taught on their courses over time. This study explored the support needs of patients with type 1 diabetes after attending a structured education programme promoting an empowerment approach and training in use of flexible intensive insulin therapy, a regimen now widely advocated and used to manage this condition. The objective was to inform future support offered to course graduates. Methods Repeat, in-depth interviews with 30 type 1 diabetes patients after attending Dose Adjustment for Normal Eating (DAFNE) courses in the UK, and six and 12 months later. Data were analysed using an inductive, thematic approach. Results While the flexible intensive insulin treatment approach taught on DAFNE courses was seen as a logical and effective way of managing one’s diabetes, it was also considered more technically complex than other insulin regimens. To sustain effective disease self-management using flexible intensive insulin treatment over time, patients often expected, and needed, on-going input and support from health care professionals trained in the approach. This included: help determining insulin dose adjustments; reassurance; and, opportunities to trouble-shoot issues of concern. While some benefits were identified to receiving follow-up support in a group setting, most patients stated a preference or need for tailored and individualised support from appropriately-trained clinicians, accessible on an ‘as and when needed’ basis. Conclusions Our findings highlight potential limitations to group-based forms of follow-up support for sustaining diabetes self-management. To maintain the clinical benefits of structured education for patients with type 1 diabetes over time, course graduates may benefit from and prefer ongoing, one-to-one support from health care professionals trained in the programme’s practices and principles. This support should be tailored and personalised to reflect patients’ specific and unique experiences of applying their education and training in the context of their everyday lives, and could be the subject of future research.
    Full-text · Article · Aug 2012 · BMC Public Health
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    • "Poor self-care behavior would seem to be the obvious explanatory variable for the decline in metabolic control, as adolescents with diabetes are more likely to have problems with self-care behavior than adults and younger children (Delameter, 2000a). Problems with self-care begin to emerge between the ages of 13 and 15 years (Glasgow et al., 1999). Although the relation of self-care to metabolic control has been somewhat inconsistent (see Delamater, 2000b; Wysocki, Greco, & Buckloh, 2003, for reviews), two recent studies found relations of self-care behavior to metabolic control. "
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    ABSTRACT: To employ a risk and resistance framework to examine changes in metabolic control over early to middle adolescence. We interviewed 70 girls and 62 boys (mean age 12 years) annually for 4 years. Risk and resistance factors, including demographics, disease-related variables, self-care behavior, and psychosocial variables were assessed. Hemoglobin A1c was obtained from medical records. Multilevel modeling showed metabolic control deteriorated with age. Self-care behavior interacted with age to predict the decline, such that self-care was more strongly related to poor metabolic control for older adolescents. Eating disturbances, depression, and peer relations were related to poor metabolic control, whereas good family relations were related to better metabolic control for girls. Independent risk factors for poor metabolic control included poor self-care, disturbed eating behavior, depression, and peer relations; parental support was an independent resistance factor for girls. Future research should examine mechanisms by which these relations emerge.
    Preview · Article · Aug 2008 · Journal of Pediatric Psychology
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