Type 2 diabetes means a person’s pancreas cannot produce enough insulin to control blood sugar levels. Overtime, rising blood sugar levels can pose serious health risks such as heart disease and strokes. The key to staving off the risks is to lead a healthy lifestyle. The trouble is, getting people to change their ways can be a tall order – this is where behavioural science steps in.
This is the focus of Professor Mike Trenell, the co-founder of Changing Health, an NHS-backed behavioural change platform for people with type 2 diabetes.
Professor Trenell has spent the last two years researching the science to work out how to “initiative behaviour change at scale”.
As Professor Trenell explained: “There are major decision points and our responsibility is to enable people when they reach a decision point to change trajectory.
“At the point of being diagnosed with Type 2 diabetes is one of those points and how do we empower people to make better, more informed decisions.”
As he sees it, the role of behavioural science is to help people become aware of the unconscious decisions they routinely make that actually worsen their type 2 diabetes symptoms and raise their risk of developing potentially life-threatening conditions.
He described a particular scenario that exemplifies these unconscious decisions: “On a Friday night do people go out and drink ten pints and have a curry or do they have a salad and white wine spritzer?
“Many of the decisions people make are made automatically and in groups.”
How can people with type 2 diabetes change their behavioural patterns?
According to Professor Trenell, the two most important aspects of behavioural change is to make a person aware of what they are doing and the second is to set a goal: “What do you want to achieve? What do you want to do?”
In his experience, the key to helping people with type 2 diabetes better manage their condition is to focus on the three things they care about: “Looking better, feeling better and having more energy”.
It is about taking those goals and tying them to important risk factors such as weight management and cardiovascular risk, he says.
It is about helping people to short circuit their reward system around a personal goal, he explained.
He added: “Most people are unaware but require pulling themselves out for a moment and then realigning whether they’re getting what they want out of it.
“We are short circuited for reward so how do you feed into that.”
Growing literature also makes a strong case for focusing on the underlying pyschosocial factors that may increase a person’s risk of developing type 2 diabetes in the first place.
According to researchers from McGill University, l’Université de Montréal, the Institut de recherches cliniques de Montréal and the University of Calgary, depression may compound the risk of developing type 2 diabetes in people with such early warning signs of metabolic disease as obesity, high blood pressure and unhealthy cholesterol levels.
“Emerging evidence suggests that not depression, per se, but depression in combination with behavioural and metabolic risk factors increases the risk of developing type 2 diabetes and cardiovascular conditions,” said lead author Norbert Schmitz, an Associate Professor in McGill’s Department of Psychiatry and a researcher at its affiliated Douglas Mental Health University Institute.
He added: “The aim of our study was to evaluate characteristics of individuals with both depressive symptoms and metabolic risk factors.”
The four-and-a-half year study divided 2,525 participants in Quebec, aged between 40 and 69, into four groups: those with both depression and three or more metabolic risk factors; two groups, each with one of these conditions but not the other; and a reference group with neither condition.
In a departure from previous findings, the researchers discovered that participants with depression, alone, were not at significantly greater risk of developing diabetes than those in the reference group.
The group with metabolic symptoms but not depression was around four times more likely to develop diabetes. Those with both depression and metabolic risk factors, on the other hand, were more than six times more likely to develop diabetes, with the analysis showing the combined effect of depression and metabolic symptoms was greater than the sum of the individual effects.