Behavioral medicine interventions in diabetes.
OBJECTIVE
Poor glycemic control is prevalent in the majority of patients with diabetes and has a strong impact on medical as well as psychological outcomes. Psychological and behavioral variables are of particular interest, as the patients themselves are the most determining factor of treatment success. Consequently, a wide range of behavioral medicine interventions are aimed at improvement in diabetes self-management, coping strategies, blood glucose awareness, and stress reduction. This review provides an overview of randomized controlled trials (RCTs) published in the past 18 months (from March 2008 to September 2009) that evaluated behavioral medicine interventions in patients with diabetes. The review summarizes the interventions' effects on metabolic control and other medical variables, as well as diabetes self-management and psychological outcomes.


RESULTS
Behavioral medicine interventions in the diabetes field encompass a number of different approaches with the goal of improving medical outcomes such as glycemic control as well as psychological outcomes. There is evidence for beneficial effects of recent behavioral medicine treatments in terms of improvement of metabolic control as indicated by decreased glycated hemoglobin (HbA1c). Furthermore, positive effects were observed regarding diabetes-related self-efficacy, self-management, proactive coping, and the reduction of psychological burdens and symptoms.


CONCLUSIONS
Behavioral medicine interventions are effective in diabetes treatment, especially in patients with a high level of diabetes-related distress, difficulty in coping, or insufficient blood glucose awareness.
Plack
Kristin
K
Department of Clinical Psychology and Psychotherapy, Johannes Gutenberg-University of Mainz, Mainz, Germany. kplack@uni-mainz.de
Herpertz
Stephan
S
Petrak
Frank
F
D003920:Diabetes Mellitus / Q000097:blood / Q000453:epidemiology / Q000628:therapy*; D006442:Glycated Hemoglobin / Q000378:metabolism; D015438:Health Behavior; D006293:Health Promotion; D006801:Humans; D010349:Patient Compliance / Q000706:statistics & numerical data; D010353:Patient Education as Topic; D012648:Self Care
D006442:Glycated Hemoglobin