Got Diabetes? A Diabetes Psychologist Can Help

In 2015, the U.S. reached a grim metabolic milestone: more than 50 percent of adults met the criteria for diabetes or pre-diabetes.¹ If this doesn't alarm you, consider that as recently as 1960, less than 1 percent of the adult population had diabetes, and the pre-diabetes diagnosis didn't exist.² Until a couple of decades ago, it was rare for a person to have diabetes or pre-diabetes. It was unusual for them even to know someone with either condition. What happened?

Beginning in the 1970s a combination of forces aligned to create a seismic shift in the lifestyle and health of the U.S. population. Government food subsidies and the infamous food pyramid ushered in an era of ultra-processed food. Restaurants and drive-through dinners replaced home cooking and family meals. Sedentary office jobs became the norm and technological advancements gave us 24-7 access to passive entertainment. Predictably, diet, exercise, and sleep habits suffered, and the early signs of the modern obesity epidemic became evident to researchers.

By 1985, diabetes rates had tripled from 1960 but this exploding growth was still beneath the radar of all but the most astute observers. Not until 1994 did the Center for Disease Control declare that diabetes had become an epidemic in the U.S. By then, sadly, the societal forces driving diabetes were irreversible.

Spring forward to 2022 and diabetes and pre-diabetes are now among the most common and costly medical conditions in the U.S. Even rates among teenagers now exceed 30 percent.³ Because diabetes and pre-diabetes have become so widespread. People are also more familiar about how diabetes is treated.

Conventionally, a person diagnosed with diabetes receives recommendations for lifestyle changes–such as weight loss, dietary modifications, and increased exercise–and prescription medicines to help manage their blood sugar levels. If blood sugar levels become severe, insulin injections may be necessary.

Tracking blood sugar, counting carbs, and taking medicines becomes the person's second job–without weekends, holidays, or a retirement plan. These ceaseless responsibilities make managing diabetes difficult for almost everyone. For some, however, it can become overwhelming. This feeling is sometimes called diabetes distress and often treated by a diabetes psychologist.⁴

Source: Thomas Rutledge/Figure 1.

For decades, diabetes psychologists have assisted people with diabetes in several important ways (See Figure 1). Because diabetes treatment regimens are often complex, for example, psychologists frequently help people identify strategies to make their treatment routines as simple and consistent as possible.

They help address diabetes-specific fears, such as overcoming the fear of needles involved with insulin. Many people with diabetes struggle to communicate effectively with friends, family, or co-workers about their condition and treatment needs. They sometimes benefit from working with a psychologist to learn new approaches to these situations.

And significant stress, frustration, and burnout (all signs of diabetes distress) may affect more than 1 in 3 people with diabetes, potentially undermining treatment and raising the risk of adverse diabetes outcomes if not identified and addressed. In the above cases, the diabetes psychologist traditionally works with other diabetes specialists–such as endocrinology and dietetics–to help people improve diabetes management and quality of life.

Over the last ten years, however, accruing research supports a new and potentially even more valuable role for diabetes psychologists: helping people reverse their diabetes.

As early as the 1980's, a remarkable diabetes result was observed among patients receiving a form of bariatric surgery called gastric bypass surgery. Specifically, most patients–often as high as 75 percent or more–showed a rapid and sustained remission of their diabetes. This is noteworthy because the American Diabetes Association (ADA) then described diabetes as a "progressive disease" with almost no mention of the possibility of reversal or remission despite many thousands of people achieving the latter through bariatric procedures.⁵

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Most recently, multiple randomized controlled trials, case studies, and literature reviews demonstrate that diabetes reversal is frequently achievable even without bariatric surgery. Lifestyle programs, for example, producing significant weight loss through calorie reduction and exercise, sleep interventions, nutrition programs reducing refined carbohydrate intake and processed foods, and intermittent fasting protocols to reduce insulin levels, have each been empirically demonstrated to help people control their blood sugar levels and in some cases reverse their diabetes to the stage of no longer qualifying for the diagnosis or requiring medication treatment.

In some behavioral treatment studies, the rate of diabetes reversal among participants was higher than 50 percent.⁶ The previously reluctant ADA acknowledges that multiple paths to diabetes reversal and remission exist.⁷ Modern diabetes psychologists play central roles in helping patients learn about and implement these potent behavioral diabetes treatments.

The significance of this evolving diabetes paradigm shift–from progression and long-term medication management to reversal and remission using behavioral or bariatric strategies–can hardly be overstated. For the first time, a person with diabetes can discuss a range of distinct treatment options with their providers that, for example, focus primarily on managing diabetes through improved blood sugar control or on the reversal and remission of diabetes by targeting insulin resistance.

Because insulin resistance is the cause of diabetes (see Figure 2), reversing insulin resistance is also the only means of reversing diabetes. And because behavioral treatments–nutrition, exercise, sleep, weight loss, and stress management–are among the most effective tools for reversing insulin resistance, having a diabetes psychologist on your treatment team can be very helpful.

To find a therapist near you, visit the Psychology Today Therapy Directory.

Source: Thomas Rutledge/Figure 2