Behavior is the heart of every diabetes intervention, according to Mary de Groot, PhD, HSPP, ADA President, Health Care & Education.

Dr. de Groot delivered her presidential address, 50 Years of Behavioral Science in Diabetes—A 2020 Vision of the Future, Saturday, June 13, at the Scientific Sessions. The presentation can be viewed by registered meeting attendees at ADA2020.org through September 10, 2020. If you haven’t registered for the Virtual 80th Scientific Sessions, register today to access all of the valuable meeting content.

Next year marks the 100th anniversary of the discovery of insulin, Dr. de Groot noted. As revolutionary as the discovery was, its ultimate success was built on a foundation of patient behavior just like every other medical or device innovation, she said.

“As I share with my patients, medications only work if we take them internally. Devices only work if we use them. The time has come to recognize and celebrate the foundational role that behavior plays in all aspects of diabetes,” said Dr. de Groot, Associate Professor at Indiana University School of Medicine.

Dr. de Groot has worked on leveraging resources for treating depression and diabetes in partnership with community exercise and behavioral health providers. She led a team in developing Program ACTIVE, a multi-state, randomized clinical trial to test the comparative effectiveness of individual cognitive behavioral therapy, community-based exercise, and concurrent delivery of them compared with usual care. The researchers found that all three interventions were effective in treating depression and psychosocial outcomes post-treatment. Combining cognitive behavioral therapy and community-based exercise for a 12-week period resulted in significant improvement in A1C values for most study participants.

The results of a cost-effectiveness analysis of the Program ACTIVE interventions are available in the Scientific Sessions ePosters.

Dr. de Groot’s research is just one example of how the knowledge base of behavioral science has expanded in the past 50 years. Large-scale interventions increasingly are tailored for effective delivery across different populations and settings, she noted.

“In the last 50 years, we have characterized the nature and impact of depression, diabetes distress, anxiety, fear of hypoglycemia, challenges to adherence, and the critical role of social support in managing type 1 and type 2 diabetes,” Dr. de Groot said. “Today, the ADA Standards of Care incorporates evaluation and treatment recommendations for the variety of psychosocial conditions that come with living with these diseases.”

The entire diabetes community must recognize that the behavioral study is a fundamental need in diabetes research and embrace the idea that behavior is an equal partner to medical innovations, Dr. de Groot said. Behavioral science and tools must have an equal place when it comes to funding, planning, and policy. That, Dr. de Groot said, requires those in the field to:

• Screen and refer patients for psychosocial conditions endemic to diabetes
• Advocate for multidisciplinary teams and share knowledge with decision makers at all levels
• Continue innovation in the delivery of integrated health care
• Support funding of behavior science research and programs
• Join with the ADA in advocating for access to affordable insulin and diabetes self-management education and support, and reducing barriers to continuous glucose monitoring access

“Today we have an evolving set of largely ad hoc individual training programs across multiple institutions and fields,” Dr. de Groot said. “A systematic funding program is needed to provide the next generation of behavioral scientists with the training opportunities needed to integrate knowledge across disciplines and clinical care environments, and to support settings in which to use their talents and training.”