Incorporating Motivational Interviewing Into Counseling for Lifestyle Change Among Overweight Individuals With Type 2 Diabetes

Abstract

Motivational interviewing (MI) was introduced as a counseling style more than a decade ago, with original applications in problem drinking,1 which expanded into exploration of utility for managing diabetes. Diabetes is a chronic health condition requiring vigilance to multiple health behaviors to optimize glycemic control and minimize both short- and long-term complications. The number, type, and extended nature of the behaviors required for optimal diabetes self-management frequently present motivational challenges for those with type 2 diabetes. MI offers some specific strategies designed to engage individuals in movement toward change. Results from several studies support the use of MI to enhance weight loss in overweight individuals with type 2 diabetes. For example, our research group demonstrated that obese women with type 2 diabetes randomized to behavior therapy plus MI had significantly better weight loss than those receiving behavior therapy plus a health education intervention (attention placebo control).2 Relative to the group receiving behavioral treatment and health education, the MI group had significantly greater weight loss at the end of the weight loss induction phase of treatment, which featured weekly sessions. This superior weight loss was sustained through the weight maintenance phase at 18 months. As might be expected with the greater weight losses, better improvements in glycemic control were apparent among those in the MI group than among those in the standard behavior therapy group, although both groups experienced marked improvements in A1C values after initial weight loss. However, these improvements attenuated over time in both groups such that there was no significant difference between the groups at the end of 18 months, although significant differences in weight loss were still apparent. Of particular interest for treatment process, analyses indicated that increased weight loss with MI was mediated by enhanced treatment engagement and program adherence. Carels et al.3 …