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William Polonsky Part 1, The Psychology of Diabetes

In part 1 of this Exclusive Interview, Dr. William Polonsky talks with Diabetes in Control Publisher Steve Freed during the ADA meeting in San Diego, California about the mission when working with a patient with diabetes – making an invisible disease visible, thus making it a priority in the patient’s life.

William Polonsky, PhD, is President and Founder of the Behavioral Diabetes Institute. He is also Associate Clinical Professor in Psychiatry at the University of California, San Diego.

Transcript of this video segment:

Steve Freed: This is Steve Freed with Diabetes in Control and we’re here at the American Diabetes Association 77th Scientific Session 2017 and we’re here to present you some really exciting interviews with some of the top endos from all across the world. And with us we have a very special guest, Dr. William Polonsky, who is very well known and he’s an expert speaker. Let’s talk a little about who you are and what you do.

William Polonksy: So I am a diabetes psychologist. I’m also a certified diabetes educator. I’m a socio-clinical professor at the University of California at San Diego, and I’m President of the Behavioral Diabetes Institute. I worked in the field of diabetes as a psychologist for just about 30 years now and focus all of my time worrying about the psychological, emotional, motivational issues in diabetes both as a clinician and a researcher.

Steve Freed: There are a couple questions I want to ask you about your presentation, but I get excited when I have you in front of me and I’m always interested in what you have to say. We know that diabetes is an epidemic, we know that diabetes is a lifestyle disease, we know if you don’t know what a carbohydrate is, you are doomed for failure and we know a lot of people with diabetes have depression and that affects their blood sugar. What do you try to accomplish with a patient, how do you do it? Because it is very difficult, number one is to get people to change lifestyles, if you’ve been doing the same thing for 40-50 years to get them to change their eating habits, to get them to change their physical therapy, that’s gotta be a high priority, number 1 or 2 on your priority list when you talk to patients or medical professionals.

William Polonsky: It’s actually usually 3 or 4 but it’s a very important thing. You know one of the biggest issues that we face, I’m thinking with you, type 2 diabetes, is that it’s really an easy disease to ignore. It’s a disease that’s so easy to say, “You know I’ll worry about this when something falls off or when something really terrible happens,” because as we know, high blood sugars doesn’t hurt, high blood pressure, high cholesterol, can’t really feel it. So we are dealing with a relatively invisible disease and all of our interventions are really about prevention. The problem with that of course is that we as human beings respond better to immediate short-term, tangible, positive things. And the idea that we are talking about a disease where you can say, “Hey Joe, listen if you can take the following medications, rebound with your life in terms with your life with what you’re eating and how you’re exercising. Try to be vigilant and lose a little weight, maybe not too much and just stay on track every day for the next 10, 20, 30, 40 years. If things work out right, here’s what in it for you, here’s what’s most likely to happen…nothing.” Because really what we’re after is the avoidance of long-term complications, I mean there’s more but that’s really the critical thing we tend to focus on. And the avoidance of nothing down the road isn’t that inspiring to us as human beings. We’re looking for immediate tangible reinforcers. So how do we take an invisible disease and make it visible so it can become more of a priority in people’s lives. One of our old strategies was to yell at people and berate them and try to scare the crap out of them, right? In general, that doesn’t work very well. So a lot of the work we do is to try to find something else. How do we help people to become enthused and engaged with their diabetes? And there’s a number of approaches we use but I would say one of the critical ones I want to share with healthcare providers is to ask them to think creatively as we have done which is how do you think about providing people with metabolic feedback and that can be blood sugars, A1c, or whatever it is and think about it as a motivational tool. Because we see it as the single most underused motivational tool there is. How do you talk to people about their A1c or about their blood sugars in a way that turns people on rather than turns people off? Because we know for so many people this can be a turn off, blood glucose monitoring can really be de-motivational. And we see that happening but it doesn’t have to. When we can talk to people about their numbers in a way that’s sensible to help people to see that look we can help you to see how your actions can make a positive difference. The psychological concept behind that is called perceived treatment efficacy, when we can help people to see that their actions are making a positive difference, it helps you to be engaged. People with diabetes see it all the time. If you’re on a diet and you weigh yourself everyday and the number on that scale is moving down, you’re going to be enthused about staying with that diet but if that number never moves or you don’t own a scale, you’re going to lose that “umph” pretty fast. Those are the kinds of things, maybe I’m speaking to vaguely about this, but those are the strategies we try to build that can make a difference.

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