Want to know what fish have to do with HbA1c, or how to make a difference in 5 minutes? Remember, #DiabetesPsychologyMatters

Highlights from #ADA2019: 79th Scientific Sessions of the American Diabetes Association

by Prof Jane Speight

The annual meeting of the American Diabetes Association was held in San Francisco: 7-11 June 2019. With over 15,000 people attending from 115 countries, it was a huge event. The Psychosocial / Behavioural Medicine stream of this conference is always strong, and a key highlight of the conference year.

As lack of time is often considered a major barrier to undertaking effective behavioural interventions in clinical practice, ‘Making a difference in 5 minutes’ was a very popular session. First to speak was Dr Bill Polonsky (Behavioural Diabetes Institute, San Diego). The irony of each speaker being given 20 minutes to talk about a 5-minute intervention was not lost on Dr Polonsky! Based on his recent research, Dr Polonsky offered 3 tips to assist health professionals in supporting people with type 2 diabetes with psychological barriers to using insulin: 1) encourage an immediate injection, 2) provide a sense of personal control (trying it for just one month), and 3) acknowledge and address the person’s obstacles and misbeliefs! Explaining the benefits of insulin, having a collaborative consultation style, and dispelling myths about insulin are all key for ensuring continued use of insulin but, Polonsky argued, overcoming anxieties about pain and needle size are pivotal to starting insulin. 

In one of the most surprising presentations of the conference, Dr Olga Gupta (University of Texas Southwestern Medical Center) offered a truly innovative 5-minute intervention for improving HbA1c in teenagers with type 1 diabetes – give them a pet fish! Dr Gupta reported on a small pilot study of 28 teenagers (read about it here), half of whom who were given a pet fish and asked to feed it one pellet of food upon waking in the morning and one pellet just before bedtime and, with each feed, check and record their own glucose levels. They were also asked to change the water in the fish tank once a week and review their logs with their parent/carer at that time. Overall, HbA1c improved by half a percentage point in the intervention group, and the effect was strongest in 10-13 year olds. One of the most striking things about Dr Gupta’s presentation was her clear demonstration of the importance of theory underpinning her study. Her intervention was based on three key theories: habit formation (embedding tasks with daily and weekly routines), family systems (focusing on adaptive family interactions) and social cognitive theory (self-efficacy reflects a sense of mastery that results from experience). Finally, another outstanding presentation in this session was delivered by Dr Susan Guzman (Behavioural Diabetes Institute, San Diego) on strategies to address diabetes burnout: 1) provide evidence-based hope, 2) establish realistic expectations, and 3) collaborate on a ‘healthy good enough’ goal and plan for action.

Finally, a key highlight of the PsychoSocial / Behavioural Medicine stream at the ADA conference, is the annual Richard R Rubin Award Lecture, recognising a scientist who has made outstanding, innovative contributions to the study and understanding of the behavioural aspects of diabetes. In 2019, this prestigious award was bestowed, for the first time, on a non-US scientist: Professor Frank Snoek (Amsterdam University Medical Centers). This was truly well-deserved, as Prof Snoek has received more than 30 major research grants and published over 200 papers in peer-reviewed journals in a career spanning more than 25 years focused on diabetes research and clinical practice. Perhaps, his strongest legacy is that he was the founding Chair (in 1995) of the PsychoSocial Aspects of Diabetes (PSAD) Study Group of the European Association for the Study of Diabetes (EASD); a group that has enabled so many of us in the field to meet, share ideas, learn from each other and develop productive collaborations. In his presentation, Prof Snoek focused very little on his own impressive contributions but, rather, on delivering a key message: mental health and behaviour change (for physical health) are two sides of the same coin: #DiabetesPsychologyMatters. Aptly, he ended his Award Lecture with a quote from Richard Rubin himself: “Coping effectively with diabetes requires emotional strength as well as coping skills”. Perhaps, remembering this one take-home message will help you make a difference in 5 minutes! 

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