Behavioral Modifications Can Lead to Successful Diabetes Management

Finding out you have diabetes is difficult. It becomes even more difficult when your doctor and members of your medical team inform you that you will need to change your lifestyle. It is as if you were being told that everything you have done is wrong. Indeed, your life style may have contributed to you developing diabetes.

This is particularly applicable if it is type 2 diabetes (T2D) because it develops due to diet, weight and other factors you have control over. Moreover, if your life style is truly at fault, you will need to change it quickly because diabetes does not just “go away”. One popular method for changing bad habits is through behavioral modification.

What is Behavioral Modification?

Altering your lifestyle is one method for gaining control of your diabetes, and that usually requires behavior modification. In other words, you have to change bad habits or behaviors that are causing you harm. This can be an important strategy for managing diabetes over a lifetime.

Behavior modification is a specific approach to treatment. The basis for it is found in operant conditioning theory. This form of therapy teaches you how to replace undesirable behaviors with desirable ones. The techniques involved include either positive or negative reinforcement. In other words, there is a carrot or a stick approach used by therapists. In the case of diabetes, you either reward or punish (term used loosely) the diabetic in order to teach the person to accept the new behaviors that can lead to a changed lifestyle.

Behavioral Modifications and Diabetes

In order for someone to control diabetes, it is essential to make lifestyle modifications. This includes changes in diet and levels of exercise or physical activity. If the diet is nutrient-prudent and the physical activity is at least moderate, the lifestyle should act to delay the onset of any potential diabetic complications. Weight loss will help maximize the positive effects. Yet, weight loss is considered to be among the hardest of the goals to achieve by many. In fact, the maintenance of weight reduction over the long-term has proven to be more difficult and increasingly more challenging than the initial weight loss.[1]

If the changes are to be sustainable and the healthy life style pattern is adopted effectively for the long term, behavioral changes are required. These changes must be long-term and adhered to vigorously.[2] Such changes require an awareness of choices, control and consequences. It will also need support from everyone associated with the diabetic. This includes friends, family, co-workers and significant others.

During the process, there are several things the individual must consider. The doctor should also consider these factors in order to determine whether the best approach for success will be self-motivated behavioral changes or group inspired changes. Either approach will require education:

  • Choices – The behavioral modification will not be successful if the patient does not choose to accept the reality of the diagnosis.
  • Control – The changes in lifestyle will not be implemented, let alone successful, if he or she cannot assume some type of responsibility and accept the need to gain control.
  • Consequences – Does the individual understand the consequences of not adhering to changing his or her lifestyle? Does the diabetic understand both the minor and major health issues that can be the result of failing to take insulin or taking insulin sporadically or incorrectly?

For some, just the thought of losing a toes or a leg will act as an incentive. To others, this is not enough. They cannot comprehend the likelihood of such a thing occurring, so the consequences don’t seem possible or real. They need to understand that managing complications from diabetes is all about reducing the risks. Behavioral modification addresses these issues. However, there is further need to consider how to increase awareness of what risk factors need to be considered.

In learning how to recognize the risk factors, you can reduce the potential consequences. This will result in the optimum preventive care approach to diabetes possible.[3]

In implementing the various aspects of a responsible diabetes control program, it is important to start in small increments. This will result in changes that will help the individual feel positive about him or herself. These are all aspects of behavioral modification. As weight decreases and exercise improves physical sensations of well-being, it becomes easier to adhere to the initial plan because these are rewards. The overall improvement in health and appearance will also act to create an improved self image.  Yet, no matter how good the intent and program is, there is always a definite need for emotional support during this process.

The Need for Emotional Support

Everyone who has been told they have diabetes needs support. As they decide to take the step to modify their lifestyle, diabetics require more than sympathy. In fact, sympathy may actually make the situation worse and encourage the postponement of making important changes in diet and exercise levels. Research strongly indicates a requirement for emotional support. It does not matter the exact source, but it is an essential component in the life of a diabetic who is adopting and adhering to what can be a drastic lifestyle change. Support may come from groups, organizations and even from peer groups or chat rooms on the internet.[4]

In providing support, it is often the role of listener that is required the most. Venting and good advice are a helpful combination. Being able to talk can help decrease the level of depression that is associated with some individuals who have diabetes. Studies reveal that emotional support is one means of reducing and/or preventing the numbers of depression incidences found in those with T2D.[5]

Research and Effectiveness

Research results on behavioral modification techniques, approaches and therapies have provided some support for this type of therapy. Rachmani et al (2005)[6] found indications that the behavioral modification failed when it was not accompanied by a thorough education on diabetes. Other factors impacting success included the human ones of lack of compliance and poor motivation. If, however, the program is a thorough and intensive one, it can be effective over the long term. For example, in one study, an exercise program using a pedometer was more beneficial when it was accompanied by the motivational support of a telephone.[7]

Conclusion

Behavioral modification can play an important role if you want to change your lifestyle in a permanent way. By changing your behaviors, you can eliminate the activities and diet that led to type 2 diabetes and then use the new behaviors to stay healthy. For those with type 1 diabetes behavioral modification provides the same diabetes management benefits. The entire process requires understanding, motivation and resolve. Education in all aspects of diabetes is a central part of the overall process.

References

[1] Klein, S; Sheard, NF; Pi-Sunyer, X; Daly, A; Wylie-Rosett, J; Kulkarni, K; and Clark, NG (2004). “Weight Management through Lifestyle Modification for the Prevention and Management of Type 2 Diabetes: Rationale and Strategies a Statement of the American Diabetes Association, the North American Association for the Study of Obesity, and the American Society for Clinical Nutrition.” Diabetes Care, 27 (8): 2067-2073.

[2] Magkos,F; Yannakoulia,M; . Chan,JL; and Mantzoros, CS (2009). “Management of the Metabolic Syndrome and Type 2 Diabetes Through Lifestyle Modification.” Annual Review of Nutrition, 29: 223-256.

[3] Boren, SA; Gunlock, TL; Schaefer, J; and Albright, A (2007). “Reducing Risks in Diabetes Self-management A Systematic Review of the Literature.” The Diabetes Educator, 33 (6): 1053-1077.

[4] van Dam,HA; van der Horst, FG; Knoops,L; Ryckman, RM; Crebolder, HFJM; and van den Borne. BHW (2005) “Social Support in Diabetes: A Systematic Review of Controlled Intervention Studies.” Patient Education and Counseling, 59 (1):1-12.

[5] Egede LE, Osborn CY (2010). “Role of Motivation in the Relationship Between Depression, Self-Care, and Glycemic Control in Adults with Type 2 Diabetes.” Diabetes Education, 36(2):276–83.

[6] Rachmani, R; Slavacheski, I; Berla, M; Frommer-Shapira R; and Ravid, M (2005). “Treatment of High-Risk Patients with Diabetes: Motivation and Teaching Intervention: A Randomized, Prospective 8-Year Follow-Up Study.” J American Society of Nephrology, 16 (Supplement): 22-26.

[7] De Greef, KP; Deforche, BI; Ruige, JB; Bouckaert, JJ; Tudor-Locke, CE; Kaufman, J-M; De Bourdeaudhui, IM (2011). “The Effects of a Pedometer-Based Behavioral Modification Program with Telephone Support on Physical Activity and Sedentary Behavior in Type 2 Diabetes Patients.” Patient Education and Counseling, 84(2): 275-279.

This article was originally published July 12, 2012 and last revision and update of it was 9/10/2015.