Clinical, Behavioral & Outcomes Research
Identifying Strategies That Improve Outcomes
Long-term complications significantly impair the health of people with diabetes. The risk of having a stroke or dying from heart disease, for instance, is two to four times greater in people with diabetes. Diabetes is also the leading cause of blindness in working-age adults and a major cause of kidney disease requiring dialysis or transplantation.
More than 100 clinical trials are under way at any given time at Joslin, ranging from studies of promising new drugs to those evaluating the impact of lifestyle changes such as weight loss and increased physical activity on the prevention or treatment of diabetes and its complications.
Researchers also are conducting clinical studies to determine how psychosocial and behavioral factors affect long-term health outcomes and overall quality of life in people with diabetes. These studies encompass the myriad aspects of living with diabetes and range from assessments of individuals to interventions applied in group settings. The section emphasizes translational and outcomes studies, so that promising concepts and educational interventions can move from the research setting into clinical practice.
Targeting Cardiovascular Disease
A number of studies under way in the section aim to identify the best strategies for improving the long-term health of participants. These studies focus particularly on finding ways to prevent cardiovascular disease. Among investigations, the Look AHEAD (Action for Health in Diabetes) Study, is comparing two interventions to determine which is most effective at preventing cardiovascular and other complications in people who already have type 2 diabetes. Half of the participants are trying to lose 10 percent of their weight and exercise more, while the other half participate in a diabetes support and education program.
Preventing Vascular Damage
Other investigations aim to prevent the early biological changes that lead to the development of diabetes, and the vascular changes that underlie many different long-term complications. Investigators in the section conduct studies to evaluate whether particular medications or lifestyle changes can improve blood-vessel health and endothelial-cell function—and thereby lower the risk of long-term complications—in people who already have diabetes.
Diabetes and the Brain
It has long been recognized that diabetes, like other chronic diseases, causes emotional reactions that can affect treatment and health outcomes. Researchers in the section strive not only to better understand the wide variety of mental health consequences of diabetes, but also to determine how psychological and social factors contribute to development of medical complications. Additionally, increasing evidence suggests that diabetes is associated with the development of mood disorders such as depression, as well as decreased cognitive function and changes in brain structure. Using advanced imaging techniques such as structural and functional magnetic resonance imaging (MRI), researchers seek to better understand the mechanisms in diabetes that may result in changes in the central nervous system.
To develop better educational and behavioral interventions aimed at improving the health outcomes of people with diabetes, scientists collaborate with both adult and pediatric clinicians at Joslin and other institutions, which has helped to speed the implementation and evaluation of individual and group-based programs aimed at improving self-care behaviors and assessing outcomes of patients with diabetes.