Skip to main content
Top

10-05-2015 | Psychosocial care | Review | Article

Diabetes and Behavioral Learning Principles: Often Neglected yet Well-Known and Empirically Validated Means of Optimizing Diabetes Care Behavior

Journal: Current Diabetes Reports

Authors: Maggie Stoeckel, Danny Duke

Publisher: Springer US

Abstract

Managing diabetes is known to be invasive, pervasive, and unrelenting, making adherence to the treatment regimen difficult to accomplish. Ongoing clinical and research efforts have attempted to address the struggles faced by youth and adults with diabetes. Recent research supports the integration of behavioral interventions into clinical practice to assist patients and families with the goal of improving health outcomes. Empirically supported and well-documented behavioral learning principles, particularly positive reinforcement, are often underutilized in modern diabetes care. We posit that most diabetes care providers are aware of these principles. However, the constraints of today’s medical systems have become significant barriers to purposefully and consistently applying them to promote improved diabetes care. We provide a brief overview of basic behavioral principles and common barriers to implementation, discuss relevant interventions, and present several examples of applications in clinical settings. We conclude with recommendations to raise awareness regarding the importance of consistently integrating relevant behavioral learning principles and interventions into diabetes care settings.
Literature
1.
Gil G, Nayak AU, Wilkins J, Hankey J, Raffeeq P, Varughese GI, et al. Challenges of emerging adulthood-transition from paediatric to adult diabetes. World J Diabetes. 2014;5:630–5.CrossRef
2.
Kurtz SMS. Adherence to diabetes regimens: empirical status and clinical applications. Diabetes Educ. 1990;16:50–6.CrossRefPubMed
3.
Diabetes Control and Complications Trial Research Group. Effect of intensive diabetes treatment on the development and progression of long-term complications in adolescents with insulin-dependent diabetes mellitus: diabetes control and complications trial. J Pediatr. 1994;125:177–88.CrossRef
4.
Benjamin RM. Medication adherence: helping patients take their medicines as directed. Public Health Rep. 2012;127:2–3.PubMedCentralPubMed
6.
Lewis A. Noncompliance: a $100 billion problem. Remington Rep. 1997;5:14–5.
7.
Renders CM, Valk GD, Griffin SJ, Wagner E, van Eijk JT, Assendelft WJJ. Interventions to improve the management of diabetes mellitus in primary care, outpatient, and community settings (Review). The Cochrane Collaboration: John Wiley & Sons; 2009.
8.
Kaplan SH, Greenfield S, Ware Jr JE. Assessing the effects of physician-patient interactions on the outcomes of chronic disease. Med Care. 1989;27:S110–27.CrossRefPubMed
9.
Stewart MA. Effective physician-patient communication and health outcomes: a review. CMAJ. 1995;152:1423–33.PubMedCentralPubMed
10.
Roter DL, Hall JA, Merisca R. Effectiveness of interventions to improve patient compliance. Med Care. 1998;36:1138–61.CrossRefPubMed
11.
Graber AL, Davidson P, Brown AW, McRae JR, Wooldridge K. Dropout and relapse during diabetes care. Diabetes Care. 1992;15:1477–83.CrossRefPubMed
12.
Dunbar JM, Marshall GD, Hovell MF. Behavioral strategies for improving compliance. In: Haynes RB, Taylor DW, Sackett DC, editors. Compliance in health care. Baltimore: The Johns Hopkins University Press; 1979.
13.
Shelton JL, Levy RL. Behavioral assignment and treatment compliance: a handbook of clinical strategies. Champaign, Illinois: Research Press; 1981.
14.
Fisher L, Glasgow RE. A call for more effectively integrating behavioral and social science principles into comprehensive diabetes care. Diabetes Care. 2007;30:2746–9.CrossRefPubMed
15.
Glasgow RE, Hiss RG, Anderson RM, Friedman NM, Hayward RA, Marrero DG, et al. Report of the health care delivery work group: behavioral research related to the establishment of a chronic disease model for diabetes care. Diabetes Care. 2001;24:124–30.CrossRefPubMed
16.
Glasgow RE, Fisher EB, Anderson BJ, LaGreca A, Marrero D, Johnson SB, et al. Behavioral science in diabetes: contributions and opportunities. Diabetes Care. 1999;22:832–43.CrossRefPubMed
17.
Watson J. Psychology as the behaviorist views it. Psychol Rev. 1913;20:158–77.CrossRef
18.
Watson J. The ways of behaviorism. New York: Harper & Brothers Pub; 1928.
19.
Skinner BF. The behavior of organisms: an experimental analysis. New York: Appleton-Century; 1938.
20.
Thorndike EL. The elements of psychology. New York: A.G. Seiler; 1905.CrossRef
21.•
Randall L, Begovic J, Hudson M, Smiley D, Peng L, Pitre N, et al. Recurrent diabetic ketoacidosis in inner-city minority patients: behavioral, socioeconomic, and psychosocial factors. Diabetes Care. 2011;34:1891–6. This study presents examples of common barriers to optimal adherence in diabetes. CrossRefPubMedCentralPubMed
22.
Hoey H. Psychosocial factors are associated with metabolic control in adolescents: research from the Hvidoere study group on childhood diabetes. Pediatr Diabetes. 2009;10:9–14.CrossRefPubMed
23.
Peyrot M, Rubin RR. Behavioral and psychosocial interventions in diabetes: a conceptual review. Diabetes Care. 2007;30:2433–40.CrossRefPubMed
24.
Petry NM, Cengiz E, Wagner JA, Hood KK, Carria L, Tamborlane WV. Incentivizing behaviour change to improve diabetes care. Diabetes Obes Metab. 2013;15:1071–6.CrossRefPubMed
25.
Petry NM, Martin B, Finocche C. Contingency management in group treatment: a demonstration project in an HIV drop-in center. J Subst Abuse Treat. 2001;21:89–96.CrossRefPubMed
26.••
Petry NM, Andrade LF, Barry D, Byrne S. A randomized study of reinforcing ambulatory exercise in older adults. Psychol Aging. 2013;28:1164–73. This study provides another critical example of the application of reinforcement to promote behavioral change. CrossRefPubMedCentralPubMed
27.••
Petry NM, Rash CJ, Byrne S, Ashraf S, White WB. Financial reinforcers for improving medication adherence: findings from a meta-analysis. Am J Med. 2012;125:888–96. This study provides a useful summary of the use of incentives to promote behavioral change, specifically medication adherence. CrossRefPubMedCentralPubMed
28.
Raiff BR, Dallery J. Internet-based contingency management to improve adherence with blood glucose testing recommendations for teens with type 1 diabetes. J Appl Behav Anal. 2010;43:487–91.CrossRefPubMedCentralPubMed
29.
Long JA, Jahnle EC, Richardson DM, Loewenstein G, Volpp KG. Peer mentoring and financial incentives to improve glucose control in African American veterans: a randomized trial. Ann Intern Med. 2012;156:416–24.CrossRefPubMedCentralPubMed
30.
Miltenberger R G. Behavioral modification: principles and procedures. Thomson/Wadsworth, 2008. p. 86.
31.
Wysocki T, Harris M, Buckloh L, Mertlich D, Lochrie A, Taylor A, et al. Randomized, controlled trial of behavioral family systems therapy for diabetes: maintenance and generalization of effects on parent-adolescent communication. Behav Ther. 2007;39:33–46.CrossRefPubMed
32.
Wysocki T, Greco P, Harris MA, Bubb J, White NH. Behavior therapy for families of adolescents with diabetes: maintenance of treatment effects. Diabetes Care. 2001;24:441–4.CrossRefPubMed
33.
Wysocki T, Harris MA, Buckloh LM, et al. Effects of behavioral family systems therapy for diabetes on adolescents’ family relationships, treatment adherence and metabolic control. J Pediatr Psychol. 2006;31:928–38.CrossRefPubMed
34.
Hood KK, Rohan JM, Peterson CM, Drotar D. Interventions with adherence-promoting components in pediatric type 1 diabetes. Diabetes Care. 2010;33:1658–64.CrossRefPubMedCentralPubMed
35.
Polonsky WH. Diabetes burnout: what to do when you can’t take it anymore. Alexandria, Virginia: American Diabetes Association; 1999.
36.
Anderson LA. Health-care communication and selected psychosocial correlates of adherence in diabetes management. Diabetes Care. 1990;13:66–76.CrossRef
37.
Lowes L, Eddy D, Channon S, McNamara R, Robling M, Gregory JW. The experience of living with type 1 diabetes and attending clinic from the perception of children, adolescents and carers: analysis of qualitative data from the DEPICTED study. J Pediatr Nurs. 2015;30:54–62.CrossRefPubMed
38.
Maslach C, Schaufeli WB, Leiter MP. Job burnout. Annu Rev Psychol. 2001;52:397–422.CrossRefPubMed
39.
Chopra S, Sotile W, Sotile M. Physician burnout. JAMA. 2004;291:633.CrossRefPubMed
40.
Whittemore R, Jaser SS, Jeon S, Liberti L, Delameter A, Murphy K, et al. An internet coping skills training program for youth with type 1 diabetes: six-month outcomes. Nurs Res. 2012;61:395–404.CrossRefPubMedCentralPubMed
41.
Franklin VL, Waller A, Pagliari C, Greene SA. A randomized controlled trial of Sweet Talk, a text-messaging system to support young people with diabetes. Diabet Med. 2006;23:1332–8.CrossRefPubMed
42.
Siemer CP, Fogel J, Van Voorhees BW. Telemental health and web-based applications in children and adolescents. Child Adolesc Psychiatr Clin N Am. 2011;20:135–53.CrossRefPubMedCentralPubMed

Be confident that your patient care is up to date

Medicine Matters is being incorporated into Springer Medicine, our new medical education platform. 

Alongside the news coverage and expert commentary you have come to expect from Medicine Matters diabetes, Springer Medicine's complimentary membership also provides access to articles from renowned journals and a broad range of Continuing Medical Education programs. Create your free account »