Diabetes is a chronic illness that requires attention to lifestyle behaviors and meticulous self-care. These requirements can be challenging for some while others have successfully incorporated their diabetes care into their lives. Those who are successful typically enjoy lowered risk of complications and a higher quality of life. The broad interest of the Weinger Lab in Behavioral Research is studying the mechanisms underlying the differential abilities to implement diabetes self-care and developing interventions and other support that clinicians can use for helping people with diabetes achieve glycemic targets and minimize the physical, emotional and social consequences.
We have examined physiologic, psychosocial and cognitive factors that impact how people with diabetes learn about and implement diabetes self-care. Using euglycemic insulin clamps, we examined patients' symptoms and intellectual function at high and low glucose levels and found many patients were monitoring symptoms that did not accurately signal high or low blood glucose levels for them, and were not monitoring symptoms that more accurately reflected early warning signs of glucose fluctuations. We have also studied psychosocial factors that influence insulin restriction behaviors by women with type 1 diabetes and the impact of insulin restriction on mortality and morbidity.
We have examined neurocognitive factors, specifically the impact of cognition and executive functions (planning, time management, and organizational abilities), on diabetes self-care for people with type 1 or type 2 diabetes. Neurocognitive factors can be associated with implementation of diabetes self-care, thus individualized interventions that address these personal differences are important to improve both glycemia and quality of life. We have tested the efficacy of interventions that could address some of the identified barriers and found that a highly structured cognitive behavioral approach was successful for both type 1 and type 2 patients in poor glycemic control. We have also found that reinforcement of prior education is helpful but an unstructured format was only successful in the short term.
Further, given the high incidence of depression in diabetes, we examined physicians' awareness of and response to diabetes patients who present with social and emotional difficulties. Physicians recognized the frequency and seriousness of these difficulties in diabetes care. Many reported that intervening with social and emotional difficulties was challenging given limited patient treatment options, time constraints, and a perceived lack of psychological expertise. Thus, recognizing and understanding physicians' challenges when treating diabetes patients' social and emotional difficulties is important for developing programmatic interventions. In a survey study of diabetes patients, we have found that those who endorsed more depressive symptoms were reluctant to discuss self-care with their providers while A1c level was not associated with willingness to discuss self-care.
Finally, an efficient and effective physician-patient relationship is of paramount importance to the health of the person with diabetes. In an effort to strengthen physician-patient collaboration, we qualitatively explored physicians' and patients' perceptions, attitudes, and behaviors that support or impede the treatment relationship. Our qualitative findings suggest physicians' and patients' differing treatment expectations, self-blame for unmet treatment targets, and reluctance to share self-care information may represent barriers in the physician-patient relationship. Medical and patient education programs can be developed to address these issues to better assist physicians and patients in managing diabetes. In a qualitative/mixed methods study, we are currently examining the impact of diabetes complications and patients' preferences for the discussion of diabetes complications at different phases throughout the course of diabetes.