A Call for More Effectively Integrating Behavioral and Social Science Principles Into Comprehensive Diabetes Care

Abstract

Research has clearly demonstrated that reductions in hyperglycemia, blood pressure, and lipids through medication and healthy living can retard diabetes progression and reduce cardiovascular risk (1). The Diabetes Prevention Program (2) has convincingly shown that healthy living and appropriate medication can reduce or even halt the progression to full diabetes for individuals with pre-diabetes. These studies used large samples of individuals who were able to adhere to the lifestyle change and medication protocols included in these clinical trials so that the effects of the interventions could be adequately documented. Applying the results of these landmark studies to the world of clinical practice has been somewhat more difficult than anticipated (3). Providing access to care for all patients, incorporating guideline-based care in clinical practice, motivating patients to initiate and sustain the essential healthy-living life changes that diabetes requires, helping patients cope with diabetes-related distress and depression, and addressing the competing priorities in health care have slowed the full application of knowledge gained by these and related studies. In clinical practice, at national meetings, and in the literature, the question most often voiced by practicing clinicians across the diabetes-related health professions is, “How do I help activate or empower my patients to take better care of their diabetes?” Despite the general consensus that weight control, balanced diet, regular physical activity, blood glucose self-monitoring, medication management, and good diabetes emotional coping and problem solving are some of the primary, evidence-based dimensions of good diabetes self-care, most patients with diabetes continue to have chronic or episodic problems achieving these goals. These problems lead to increased morbidity and mortality, high health care costs, and often high frustration among both patients and practitioners. Despite the enormous advances in sophisticated medications and diabetes-related devices based on recent advances in genetics, biotechnology, and bio-engineering, we are left with …