Magazine article Clinical Psychiatry News

Use Behavioral Strategies to Help Manage Diabetes

Magazine article Clinical Psychiatry News

Use Behavioral Strategies to Help Manage Diabetes

Article excerpt

SAN FRANCISCO -- Here's what doesn't work when trying to help patients self-manage their diabetes:

* Urging them to use more willpower. "You need to get serious about your diabetes."

* Threatening them with bad outcomes. "Do you want to go blind? Is that what you want?"

* Giving them advice. "Maybe if you joined a nice fitness center ..."

These strategies don't work because they're based on the flawed premises that people are unmotivated, lazy, or in denial about their diabetes, said William Polonsky, Ph.D., at a meeting sponsored by the American Diabetes Association.

"There's no evidence for this, and there's pretty good evidence that this is wrong," said Dr. Polonsky, a psychologist who founded and directs the Behavioral Diabetes Institute in San Diego.

Although data on how to help patients improve selfcare are scarce, Dr. Polonsky said the following seven core behavioral strategies seem likely to make a difference:

* Make it real. Many patients don't think that having diabetes is a big deal. Give them personalized metabolic feedback about their hemoglobin [A.sub.1c] (Hb[A.sub.1c]) levels, blood pressure, and lipid levels. Instead of talking about "good" or "bad" levels, talk about "safe" ranges, and being in a "safe place" or "unsafe place" with these metabolic measures, Dr. Polonsky suggested.

A pilot study he led recently invited 36 patients with type 2 diabetes to a "Diabetes Extravaganza," a festive 2-hour group session designed to make diabetes seem more "real" by helping patients understand their metabolic data.

Before the end of the session, patients were given a form with their Hb[A.sub.1c], blood pressure, and LDL cholesterol levels and asked to check off whether their levels were "safe" or not. The average baseline Hb[A.sub.1c] level of 9.1% declined to 7.9% just 3 months later, a mean decline of 1.2% that was statistically significant.

* Make it hopeful. Pop quiz: Diabetes is the leading cause of adult blindness, amputation, and kidney failure. True or false?

False. Poorly controlled diabetes leads to these problems.

"Well-controlled diabetes is the leading cause of nothing," Dr. Polonsky said. A study of 326 people who have lived with diabetes for at least 50 years found that 52% had no retinopathy, 50% had no neuropathy, and 47% had no complications at all. …

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