diabetes - Journal of Consulting and Clinical Psychology...

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Diabetes and Behavioral Medicine: The Second Decade Linda A. Gonder-Frederick, Daniel J. Cox, and Lee M. Ritterband University of Virginia Health System Diabetes management depends almost entirely on behavioral self-regulation. Behavioral scientists have continued a collaboration with other health systems researchers to develop a holistic approach to this disease. The authors summarized the literature in 4 major areas: self-management of diabetes, psycho- social adjustment and quality of life, neuropsychological impact, and psychobehavioral intervention development. Progress made in each of these areas over the past decade is highlighted, as are important issues that have not yet received sufficient scientific attention. Emerging areas likely to become central in behavioral research, such as diabetes prevention, are introduced. The future of behavioral medicine in diabetes is also discussed, including topics such as the changing role of psychologists in diabetes care, the urgent need for more and better intervention research, the growing importance of incorporating a health system–public health perspective, and obstacles to the integration of psychobehavioral approaches into routine health care delivery. A profound event in diabetes management during the past decade was the release of the 1993 report of the National Institutes of Health (NIH) funded Diabetes Control and Complications Trial (DCCT; DCCT Research Group, 1993), which radically altered both the goals and the philosophy of treatment of this disease. The DCCT was a controlled, prospective trial following more than 1,400 adults and adolescents with Type 1 diabetes (T1DM) over an average of 6.5 years. The results provided strong evidence that the use of intensive treatment regimens to maintain tighter glucose control can delay or prevent the development of at least some of the devastating long-term complications of diabetes, in- cluding retinopathy and nephropathy. Subsequent studies repli- cated these findings and demonstrated the benefits of maintaining tighter metabolic control for patients with Type 2 diabetes (T2DM; Ohkubo et al., 1995; Reichard, Nilsson, & Rosenqvist, 1993; It is almost impossible to overestimate the impact of the DCCT on diabetes treatment and research. Seemingly overnight, large numbers of patients were expected to follow a demanding, inten- sive treatment regimen that previously had been recommended only for those who were most highly motivated and diligent in their diabetes self-management. Health care practitioners were also expected to know how to help patients achieve these lofty treat- ment goals. In addition to problems in implementing intensive treatment, questions arose concerning the effects of these regimens on quality of life (QOL) for patients. Intensive regimens also posed new dilemmas for health care practitioners and patients, not the least of which was the dramatic increase in risk for episodes of severe hypoglycemia when patients attempted to lower blood
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diabetes - Journal of Consulting and Clinical Psychology...

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