Balancing the three-legged stool of diabetes care

Behavioural highlights from #EASD2018 in Berlin

by Prof Jane Speight and Prof Frans Pouwer

With around 16,000 people attending, the European Association for the Study of Diabetes (EASD; 1-5 Oct 2018, Berlin) was a mammoth meeting and well worth a visit. Here, ‘the great and the good’ of diabetes come together to share the latest findings and provide impressive overviews of their fields of research. It is no doubt an important meeting in the diabetes calendar, and many new announcements were made. You can view or read a summary here of some of the medical highlights of EASD, given by Prof Simon Heller to Medscape. While new developments in diabetes often focus on biomedical and technological advances, these raise rather than remove important behavioural and psychological issues, as discussed here. So, it was disappointing to see how few EASD presentations were focused on the psychological and behavioural aspects of diabetes.

On Wednesday morning, there was an outstanding symposium on ‘Behavioural diabetes and technology: where is it going?’ organised by the EASD’s official study group focused on psychosocial aspects of diabetes (the PSAD). It featured presentations by Prof Frank Snoek (online psychosocial interventions), Prof Norbert Hermanns (psychological aspects of glucose sensing technologies) and Prof Katharine Barnard psychological impact of diabetes apps and blogs), which you can read about here. This expert overview was attended by around 50-100 delegates, likely because it was not well advertised by the EASD, and was relegated to a small hall at the far end of the top floor of the conference centre. To our knowledge, this was the case for all the EASD’s Study Group symposia.

The EASD has no fewer than 18 official Study Groups, and one of the oldest continually functioning groups is the PSAD, established in 1995 in Madrid. The Study Groups are the essence of the EASD’s work, promoting networking among researchers to enable scientific discovery to solve specific problems. So, it is disappointing that they are not given greater profile during the congress to showcase their work, increase their memberships, and influence the next generation of clinicians and researchers. It is also noteworthy that there are no PSAD members on the EASD programme organising committee (see here, p18-19). Both the American Diabetes Association and Diabetes UK conferences have strong behavioural/psychological streams throughout their professional conferences, while the IDF World Diabetes Congress has a prominent ‘Living with diabetes’ stream. A more visible psychosocial stream running throughout the EASD would be very welcome: it would encourage greater attendance by the behavioural and psychological research community, and enable the wider clinical diabetes community to learn from this expertise.

Other oral presentations focused on psychosocial aspects of diabetes were few and far between at the EASD. Two of the most notable were given during industry satellite symposia. On Wednesday evening, during the International Hypoglycaemia Study Group (IHSG) sponsored by Novo Nordisk, Prof Stephanie Amiel gave an overview of the rarely acknowledged psychological burden of hypoglycaemia on family members. A video of this symposium will likely be available on the IHSG website in due course. On Thursday evening, Dr Michael Vallis presented ‘How to support sustained behaviour change’ during a satellite symposium hosted by Novo Nordisk. On Friday morning, in a symposium on digital health, Dr David Klonoff emphasised the important role of rigorous behavioural science in the development of effective diabetes ‘apps’. The final symposium of the congress was entitled: ‘Diabetes and the Mind: psychological aspects’, featuring presentations by Dr Bill Polonsky (diabetes distress), Prof Frans Pouwer (depression and anxiety) and Prof Thomas Danne (the role of glycaemic variability in reducing distress). Arguably, the EASD had saved some of the best presentations until last – unfortunately, most delegates had already left the building. Many of the EASD’s oral presentations are available to view on the EASD’s virtual meeting portal. We encourage you to take the opportunity to watch these if you can.

Despite the many impressive treatments and technologies available in diabetes care today, the collective message from all the eminent behavioural diabetes experts at the EASD was that none can work without the right mindset. Psychology is not an optional extra. If diabetes care is the seat of a three-legged stool, then it is supported by three legs: psychology/education, treatment/technology and complications screening. It seems ironic that so much funding, resource and effort is put into strengthening and promoting the treatment/technology and complications ‘legs’, while the psychology/education ‘leg’ remains short and weak. With uneven legs, the diabetes care stool is doomed to wobble! We acknowledge that publishing basic science and the latest trials of new medications is important, but we urge the EASD to realise that these are not the only aspects of diabetes research and care that matter if we are to improve the outcomes of people affected by diabetes.