50 years of Behavioural Science in Diabetes: What’s Next?

Dr Mary de Groot considers the history and future of this vital area of research

By Jasmine Schipp

Dr Mary de Groot is a clinical health psychologist. Her research focuses on diabetes and depression. She has a family history of type 1 and 2 diabetes. This experience led her to devote her life to this work. In 2020, Dr de Groot was President of Healthcare and Education of the American Diabetes Association (ADA). Her ADA speech marked 50 years of behavioural research in diabetes. She talked about the history and the future of this movement. This speech was published recently in Diabetes Care.

The History

Behavioural research in diabetes focuses on how people with diabetes feel and what they do. This is the focus of what we do at the ACBRD. Behavioural research can be done in various ways. It includes a range of research that spans:

      • understanding how people think and feel, and why they do what they do. This work often involves interviewing people or asking them to complete questionnaires
      • designing interventions to support people or to change behaviour
      • trials of interventions and evaluating real-world impact

This field has grown in popularity. A diverse group of people now work in this area. These include nurses, social workers, and psychologists. Now we have learnt how to tell when someone needs more support. Over the last 50 years, we have learnt about several important issues that affect diabetes care. In 2016, the ADA produced a landmark position statement: “Psychosocial Care for People with Diabetes”.

The Future

Dr de Groot calls this the next “Golden Age” of behavioural research in diabetes. She made several suggestions and predictions. A key next step is integrated care. This means having mental health support available as part of clinical care. This will help people with diabetes to get the support they need.

Another major area will be learning how to prevent (some forms of) diabetes and treat all diabetes earlier. We need to eliminate the many forms of diabetes stigma, as this is key to creating a world in which people with diabetes can thrive. An important report is the ADA and AADE joint publication on the use of language in diabetes care. Based on Diabetes Australia’s 2012 position statement, Dr de Groot suggests that this is a “landmark template for us all to follow to set the words and tone in our communication… and, by doing so, reduce the cognitive traps that hinder successful self-care”.

To all this, we need to support the next generation of researchers and clinicians. This will require a systematic funding program and strong advocacy.


COVID-19 taught us an important lesson. Our first line of defence was to change our behaviours. These included washing hands and ‘social distancing’. This helped to prevent the spread of COVID-19. We need to think about healthy behaviours when it comes to diabetes too. Taking medications and exercising are behaviours. Behaviours underpin everything we do. Behavioural research can teach us how to support and prevent diabetes. As Dr de Groot states:

Let us not forget that it is behaviour that is the foundation of the success of every innovation in medications and devices… medications only work if we take them. Devices only work if we use them. The time has come to recognize and celebrate the foundational role that behaviour plays in all aspects of diabetes.”

You can read more about behaviour change in our blogs.

The ACBRD has developed factsheets on several of the topics discussed in Dr de Groot’s  speech, which you can read here:

de Groot M, 50 Years of Behavioral Science in Diabetes: A 2020 Vision of the Future. Diabetes Care, 2021; 44 (3): 633-640.

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