Sunday, June 26, 2016

At risk for diabetes? Here's how to prevent it.

Psychology holds a strange position in modern medicine because we live in a time when everyone believes there is a pill that can solve their problems, and yet many common illnesses in medicine (e.g., pain, depression) are treated more effectively with behavioral medicine than pharmaceuticals. This week, I would like to share with you one of the original studies that showed us just how profound an impact psychologists and other mental health professionals can have on medical problems, specifically diabetes. 

American Diabetes Association
According to the CDC, 30 million people in the United States have diabetes. For more on diabetes from the CDC click here.  

In 2002, the Diabetes Prevention Program Research Group published the results of a 5 year study examining treatment outcomes for people at risk for diabetes. They asked the questions can you prevent diabetes? And what works: drugs or lifestyle change?

To answer these questions, they recruited 3,234 individuals who were at risk of diabetes based on their fasting glucose levels. These individuals were about 51 years old, 68% female, 45% belonged to an ethnic minority group, and the average BMI was 34 (BMI > 30 is considered obese). 

Each participant was then randomly assigned to 1 of 3 groups: placebo, Metformin, or Lifestyle change. The placebo group took 2 pills per day for the duration of the study. Metformin is the most commonly prescribed, 1st line treatment for Type 2 Diabetes. Participants in the Metformin group took an 850mg pill of Metformin twice daily for the duration of the study. 

Participants in the Lifestyle change group were assigned to a mental health professional who guided them through a 16-lesson curriculum in weekly, one-on-one meetings for 24 weeks. The goals of this program were to help the participant maintain 150 minutes of physical activity per week and reduce their body weight by 7%. By the end of the 24 week curriculum, 50% of participants had maintained the 7% weight loss and 74% of participants had maintained their physical activity regimenAfter 24 weeks, participants continued to meet with their behavioral therapist monthly for the duration of the study in order to review and reinforce these lifestyle changes. 

To determine the effectiveness of these treatments, each participant was tested annually for diabetes using an oral glucose tolerance test. Over the next 5 years, the incidence of diabetes was 11% in the placebo group, 7.8% in the Metformin group, and 4.8% in the Lifestyle change group. In other words, Metformin was effective in reducing the incidence of diabetes by 31% whereas the behavioral Lifestyle change program was effective in reducing diabetes by 58%. 

Needless to say, these results caught the medical world by storm. First, no one really expected that behavioral medicine could be more effective than the gold standard medical treatment. Second, the world hadn't really considered how to leverage the power of mental health professionals in healthcare. Luckily, this was almost 15 years ago, and integrated primary care is becoming more commonplace. 

The WHO defines health as "a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity," but we still have a long way to go. It seems as though many people still believe working with a mental health professional is only meant for extreme cases. Yet, these data are pretty clear that working with an expert in behavioral medicine, such as clinical psychologists, can be extremely effectively in maintaining health goals that going far beyond depression and anxiety. 

Diabetes Prevention Program Research Group. (2002). Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl j Med2002(346), 393-403.

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