Behavior-Analytic Approaches to the Management of Diabetes Mellitus: Current Status and Future Directions
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DISCUSSION AND REVIEW PAPER
Behavior-Analytic Approaches to the Management of Diabetes Mellitus: Current Status and Future Directions Bethany R. Raiff 1
&
Connor Burrows 1 & Matthew Dwyer 1
# Association for Behavior Analysis International 2020
Abstract Diabetes mellitus is the seventh leading cause of death in the United States, requiring a series of complex behavior changes that must be sustained for a lifetime (e.g., counting carbohydrates, self-monitoring blood glucose, adjusting insulin). Although complex, all of these tasks involve behavior, making them amenable targets for behavior analysts. In this article, the authors describe interventions that have focused on antecedent, consequent, multicomponent, and alternate procedures for the management of diabetes, highlighting ways in which technology has been used to overcome common barriers to the use of these intensive, evidence-based interventions. Additional variables relevant to poorly managed diabetes (e.g., delay discounting) are also discussed. Future research and practice should focus on harnessing continued advances in information technology while also considering underexplored behavioral technologies for the effective treatment of diabetes, with a focus on identifying sustainable, long-term solutions for maintaining proper diabetes management. Practical implementation of these interventions will depend on having qualified behavior analysts working in integrated primary care settings where the interventions are most likely to be used, which will require interdisciplinary training and collaboration. Keywords Behavior analysis . Diabetes . Technology
Diabetes mellitus is the seventh leading cause of death in the United States and occurs when an individual experiences hyperglycemia (i.e., high levels of blood glucose), either as a result of insulin resistance (Type 2 diabetes) or because the pancreas does not produce insulin (Type 1 diabetes; American Diabetes Association, 2018a, b). In 2015, approximately 30.3 million U.S. citizens had diabetes, and 1.5 million new diagnoses were said to occur each year (American Diabetes Association, 2018c). Type 1 diabetes (T1D) occurs when the body’s immune system destroys the beta cells that create insulin in the pancreas, either due to genetics or a virus, whereas Type 2 diabetes (T2D) is the result of genetic, lifestyle, and environmental factors (National Institute of Diabetes and Digestive and Kidney Diseases, 2016). Regardless of type, if blood glucose is not maintained within a normal range, a host of health complications will arise, including
* Bethany R. Raiff [email protected] 1
Department of Psychology, Rowan University, 201 Mullica Hill Road, Glassboro, NJ 08028, USA
ketoacidosis, retinopathy, nephropathy (e.g., hypertension, renal failure, renal insufficiency), neuropathy, stroke, foot wounds, gangrene, cardiovascular disease (e.g., myocardial infarction, heart failure, atherosclerosis, aneurysm), and eventually death (Young et al., 2008). Diabetic foot ulceration represents the leading cause of hos
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