Understanding diabetes and the role of psychology in its prevention and treatment.

124

As members of multidisciplinary diabetes care teams, psychologists are well-suited to support self-management among youth with Type 1 diabetes (T1D) and Type 2 diabetes (T2D) and their families. Psychological and behavioral interventions can promote adherence to the complex and demanding diabetes care regimen, with the goals of promoting high quality of life, achieving optimal glycemic control, and ultimately preventing disease-related complications. This article reviews well-researched contemporary behavioral interventions to promote optimal diabetes family- and self-management and health outcomes in youth with T1D, in the context of key behavioral theories. The article summarizes the evidence base for established diabetes skills training programs, family interventions, and multisystemic interventions, and introduces emerging evidence for technology and mobile health interventions and health care delivery system interventions. Next steps in behavioral T1D intervention research include tailoring interventions to meet individuals’ and families’ unique needs and strengths, and systematically evaluating cost-effectiveness to advocate for dissemination of well-developed interventions. Although in its infancy, this article reviews observational and intervention research for youth with T2D and their families and discusses lessons for future research with this population. Interventions for youth with T2D will need to incorporate family members, consider cultural and family issues related to health behaviors, and take into account competing priorities for resources. As psychologists and behavioral scientists, we must advocate for the integration of behavioral health into routine pediatric diabetes care in order to effectively promote meaningful change in the behavioral and medical well-being of youth and families living with T1D and T2D.

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confidence: 99%

Evidence-based behavioral interventions to promote diabetes management in children, adolescents, and families.

Hilliard¹,

Powell²,

Anderson³

2016

124

“…This requires maintaining a balance between dietary intake, energy exertion through physical activity and oral and/or injectable medications (e.g., insulin) for the entire life span following diagnosis (ADA, 2015). See Hunter (2016) for more information on T1D and T2D and their treatments.…”

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confidence: 99%

Psychological conditions in adults with diabetes.

Groot

Golden

Wagner

2016

138

Type 1 (T1D) and Type 2 diabetes (T2D) represent a demanding set of biopsychosocial challenges for patients and their families, whether the age of disease onset occurs in childhood, adolescence, or adulthood. Psychological conditions, defined as syndromes, disorders, and diabetes-specific psychological issues affect a larger proportion of individuals with T1D and T2D compared to the general population. In this review, we summarize the prevalence, impact and psychological treatments associated with the primary categories of psychological conditions that affect adults with T1D and T2D: depressive symptoms and syndromes, anxiety disorders, eating behaviors and disorders and serious mental illness. The implications of the literature for psychologists are discussed, and priorities for future research to advance the science of psychological conditions for adults with T1D and T2D are identified.

“…Health disparities for both T1D and T2D exist, such that lower SES and racial/ethnic minority populations experience poorer diabetes management and greater burden of disease across the life span (Hunter, this issue). Complex societal and economic factors can create barriers to effective diabetes management at multiple levels that are not under the direct control of the individual or members of their social context.…”

Section: The Macrolevel Social Context Of Diabetes Managementmentioning

confidence: 99%

“…These social resources and the nature of their involvement change across development, and may be particularly important during major developmental transitions. As individuals increasingly live longer with diabetes (Hunter, this issue), it is imperative to understand how to utilize support resources to enhance diabetes management and quality of life in patients and families.…”

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confidence: 99%

“…It should be noted that research has focused mostly on T1D during childhood to emerging adulthood, and on T2D during adulthood, consistent with the age at which diabetes is commonly diagnosed. Although T1D and T2D require different treatment regimens (see Hunter, this issue), both have complex behavioral demands that can be challenging to patients and support providers.…”

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confidence: 99%

See 1 more Smart Citation

The social context of managing diabetes across the life span.

Wiebe¹,

Helgeson²,

Berg³

2016

108

Diabetes self-management is crucial to maintaining quality of life and preventing long-term complications, and occurs daily in the context of close interpersonal relationships. This article examines how social relationships are central to meeting the complex demands of managing type 1 and type 2 diabetes across the life span. The social context of diabetes management includes multiple resources, including family (parents, spouses), peers, romantic partners, and health care providers. We discuss how these social resources change across the life span, focusing on childhood and adolescence, emerging adulthood, and adulthood and aging. We review how diabetes both affects and is affected by key social relationships at each developmental period. Despite high variability in how the social context is conceptualized and measured across studies, findings converge on the characteristics of social relationships that facilitate or undermine diabetes management across the life span. These characteristics are consistent with both Interpersonal Theory and Self-Determination Theory, two organizing frameworks that we utilize to explore social behaviors that are related to diabetes management. Involvement and support from one’s social partners, particularly family members, is consistently associated with good diabetes outcomes when characterized by warmth, collaboration and acceptance. Under-involvement and interactions characterized by conflict and criticism are consistently associated with poor diabetes outcomes. Intrusive involvement that contains elements of social control may undermine diabetes management, particularly when it impinges on self-efficacy. Implications for future research directions and for interventions that promote the effective use of the social context to improve diabetes self-management are discussed.