Outlook: A Quarterly Newsletter of the Society of Behavorial Medicine
Spring/Summer 2009 Return to Outlook Main page >>

A New Home for Diabetes Behavioral Medicine Research at SBM

Nicole Bereolos, PhD, MPH

Jeffrey S. Gonzalez, PhD, Diabetes SIG Chair

The Diabetes SIG was initiated at last year's SBM meeting to attract members from multiple disciplines who are committed to the advancement of behavioral and psychological research in diabetes. Type 2 diabetes has reached epidemic proportions in most parts of the world and it is a public health priority to decrease its prevalence. Behavioral interventions aimed at reducing risk factors for diabetes such as obesity and sedentary lifestyle are urgently needed. Improving quality of life and disease outcomes for patients living with diabetes is also increasingly important and addressing behavioral factors is necessary to achieve these outcomes, including improving diabetes self-care and treatment adherence, reducing diabetes-related distress, and addressing common psychological problems such as depression, anxiety, and eating disorders. Behavioral medicine is uniquely situated to address these problems through interdisciplinary collaboration involving physicians, psychologists and other mental-health professionals, dietitians, public health specialists, nurses, health educators, and others. The Diabetes SIG seeks to foster collaboration across these disciplines and to support creative approaches to the prevention of type 2 diabetes and to improving outcomes for both type 1 and type 2 diabetes. As diabetes disproportionately affects children and adults from ethnic minority backgrounds and disadvantaged social classes, we are particularly interested in attracting investigators and clinicians with expertise in working with these populations.

The importance of behavioral medicine in the management of type 2 diabetes was on prominent display at SBM's 2009 Meeting where Dr. Wayne Katon presented a keynote address on depression and diabetes. Research has consistently shown that patients with diabetes are more likely to experience depression than the general population. Furthermore, the presence of depression is associated with poorer quality of life and increases in hyperglycemia (1), risk of complications (2), functional impairment (3), and risk of mortality (4). Depression is also consistently associated with poorer diabetes self-care (5), even at subclinical levels (6). Thus, there has been much interest in whether treatments for depression can also impact diabetes health behavior and treatment outcomes. However, most existing depression treatment trials have had modest effects on depression outcomes and have generally failed to positively impact diabetes self-care or glucose control (7). As investigators continue to search for more effective interventions, important questions remain. For example, it remains unclear whether the relationship between depression and worse diabetes outcomes is causal and, if so, which behavioral and/or biological mechanisms may explain the effect of depression on worse outcomes. Questions also remain as to why depression is more common in patients with diabetes. While it seems intuitive to expect that the experience of chronic illness would have a negative impact on mood states, recent epidemiological research has suggested that depression may precede and be an independent risk factor for the development of type 2 diabetes (8). This represents just one of many exciting opportunities for behavioral medicine research to make contributions to both the prevention of type 2 diabetes and the improvement of outcomes for all patients with diabetes. We hope that the Diabetes SIG will increase the visibility of behavioral medicine research that is relevant to diabetes and draw new investigators to tackling this important problem.

Nicole Bereolos, PhD, MPH
University of Texas School of Public Health, Dallas Regional Campus
Dallas, TX

Jeffrey S. Gonzalez, PhD
Ferkauf Graduate School of Psychology and Albert Einstein College of Medicine, Yeshiva University, Bronx, NY


  1. Lustman PJ, Anderson RJ, Freedland KE, de Groot M, Carney RM, Clouse RE (2000). Depression and poor glycemic control: a meta-analytic review of the literature. Diabetes Care 23, 934-942.
  2. de Groot M, Anderson R, Freedland DE, Clouse RE, Lustman PJ (2001). Association of depression and diabetes complications: a meta-analysis. Psychosomatic Medicine, 63, 619-620.
  3. Egede LE (2004). Diabetes, major depression, and functional disability among U.S. adults. Diabetes Care, 27, 421-428.
  4. Katon WJ, Rutter C, Simon G, Lin EHB, Ludman E, Ciechanowski P, Kinder L, Young B, and Von Korff M (2005). The association of comorbid depression with mortality in patients with type 2 diabetes. Diabetes Care, 28, 2668-2672.
  5. Gonzalez JS, Peyrot M, McCarl L, Collins EM, Serpa L, Mimiaga M, Safren SA (2008). Depression and diabetes treatment nonadherence: a meta-analysis. Diabetes Care, 31, 2398-2403.
  6. Gonzalez JS, Safren SA, Cagliero E, Wexler DJ, Wittenberg E, Delahanty L, Blais MA, Meigs JB, Grant RW (2007). Depression, self-care, and medication adherence in type 2 diabetes: relationships across the full range of symptom severity. Diabetes Care, 30, 2222-2227.
  7. Markowitz S, Gonzalez JS, Wilkinson J, Safren SA (In Press). A review of treating depression in diabetes: emerging findings. Psychosomatics.
  8. Mezuk B, Albrecht S, Eaton W, Golden SH (2008). Depression and type 2 diabetes over the lifespan: a meta-analysis. Diabetes Care, 31, 2383-2390.