Feature

Richard Rubin, PhD, will be the first psychologist to take the reins of the American Diabetes Association (ADA) in June 2006--a role he'll use to spark greater awareness among the health-care community and the public that diabetes is a behavioral health issue, not just a physical one.

Rubin, ADA's former vice president, became president-elect in June, and has begun laying the foundation for his one-year presidency. In his new role, the social psychologist hopes to partner with the American Psychological Foundation (APF) and other organizations to train psychologists to work with the emotional aspects of the disease--such as denial, anger, depression and guilt.

The need is evident: The number of people with diabetes worldwide is expected to double to 366 million by 2030, according to the World Health Organization and the International Diabetes Foundation.

"I want more and more people to understand that behavior and emotions play a part in diabetes and how that affects human and economic outcomes," says Rubin, an associate professor in the medicine and pediatrics department at Johns Hopkins University who has studied diabetes for more than 25 years. In retrospect, "I was probably born to this job," he adds.

The psychosocial connection

Indeed, Rubin's new role hits close to home. Rubin was a teenager when his younger sister was diagnosed with diabetes. Then, 20 years later, his son was diagnosed with the disease.

"From that time, diabetes has been a part of my family--with all of its psychological implications," Rubin says.

After his son's diagnosis in 1979, Rubin devoted his clinical practice and his research to working with and studying how people manage the challenges and frustrations of diabetes.

As part of his ADA presidential mission, Rubin will emphasize the role emotions play in influencing a person's diabetes self-care behavior and the extent that self-care behavior influences treatment outcomes. In fact, he says, people make 99 percent of the clinically relevant decisions themselves when they make day-to-day choices about diet, activity, medication-taking and blood glucose Monitoring. People's behavior can affect their risk of developing diabetes in the first place, he notes.

Along with a team of more than 100 researchers across the country, Rubin is involved in the Diabetes Prevention Program (DPP). The study found that a lifestyle intervention for U.S. adults at high risk for developing Type-II diabetes was able to decrease the risk of developing the disease by 58 percent over a three-year trial. The lifestyle intervention included individualizing counseling to change behaviors regarding diet, physical activity and weight. The study appeared in the February 2002 issue of the New England Journal of Medicine (Vol. 346, No. 6, pages 393-403).

In addition, Rubin and others have begun discovering evidence that depression may increase a person's risk for developing Type-II diabetes. Some studies have shown that depressed people are two to three times more likely to develop diabetes than those who are not depressed--as a result of behavioral and neurohormonal changes associated with depression. A study of depression among DPP participants, led by Rubin, appeared in April's Diabetes Care (Vol. 28, No. 4).

Increasing psychologists' role

As psychologists find stronger links between a person's psyche and blood sugar levels, Rubin views now as a ripe time for a psychologist to lead ADA.

"What we need now," he says, "is more psychological and behavioral research and much better care for people's psychosocial needs."

To set that in motion, as ADA president, he hopes to team with APF to obtain funding to develop a training protocol to prepare psychologists to work with diabetic individuals and their families.

Rubin anticipates that organizations such as APF can help him to raise awareness of diabetes' emotional and behavioral aspects.

The message can stretch beyond diabetes too, says APF President Dorothy W. Cantor, PsyD. "We could use this as our basic model of training psychologists to work with people with diabetes and their families and adapt it to do the same for those with coronary disease or cancer," she says.

Further Reading

  • Anderson, B.J., & Rubin, R. (Eds.). (2002). Practical psychology for diabetes clinicians (2nd ed.). Alexandria, VA: American Diabetes Association.

  • Rubin, R., Biermann, J., & Toohey, B. (1999). Psyching out diabetes: A positive approach to your negative emotions (3rd ed.). Los Angeles: Lowell House.