The American Diabetes Association presented the Behavioral Medicine and Psychology Distinguished Contributions Award to Yale School of Nursing Dean Margaret Grey, DrPH, RN, FAAN, at the Association’s 73rd Scientific Sessions last week in Chicago.
The award recognizes a behavioral researcher who has made outstanding and/or innovative contributions in the study and understanding of behavioral aspects of diabetes. Dean Grey is co-director of the Multidisciplinary Research Training Program in Behavior and Type 1 Diabetes.
“Nurse-scientists have made major contributions to behavioral science and diabetes that too often go unnoticed,” explained Dean Grey. “This award provides me with a bully pulpit to help set the record straight.”
“Nurses and nurse researchers tend to be a little different because they include both the physical and the psychosocial in their assessment,” continued Dean Grey, who presented the newly named Richard R. Rubin Award Lecture at The Scientific Sessions (this year is the first time in its eight-year history that it has been awarded to a nurse researcher). Her lecture was titled "The 'White Cap' Advantage—Contributions of Nurses to Behavioral Research in Diabetes."
Dr. Grey’s research focuses on the integration of the mind and diabetes outcomes, which set her on a quest to discover what behavioral and psychosocial factors drive outcomes in children and adolescents. What she found is that kids who are active problem-solvers do much better dealing with the challenges presented by type 1 diabetes than similar patients who take a more passive approach to life. This discovery led to the first randomized clinical trial of behavioral-education intervention in teenagers with type 1 diabetes.
“We found that kids who got the intervention compared to a standardized diabetes education program got significantly improved A1C and improved quality of life,” Dean Grey said. “It was the first, large randomized clinical trial to show that behavioral interventions can, in fact, improve metabolic control as well as quality of life.”
Dr. Grey’s original studies focused on group interventions. But as the teens’ lives became busier, it became more difficult to assemble groups, she said. Her solution was an Internet-based intervention designed to teach the same coping skills that were successful in the group setting.
“This is an online intervention conducted at school, at home, [or] wherever kids could access the Internet,” she explained. “What we found was that both interventions helped, but there was a huge satisfaction increase with the online program. Those kids who did both programs had lower A1C and improved quality of life than those kids who did just one program.”
Her work is a classic example of nurse-scientist research, Dean Grey said. “Most researchers look at just A1C,” she said. “One of the things I’ve found reviewing the literature is a theme of nurse researchers looking for innovative ways to reach patients. Nurses want to ensure that what we do not only has the right clinical outcomes, but that people are satisfied with the program and provide feedback on the intervention itself.”
With a long-standing, extramurally-funded program of research, Dean Grey has developed a program to enhance coping skills in teens with type 1 diabetes (Coping Skills Training) and showed that this program leads to improvement in glycemic control and quality of life. Recently, she led the modification of this program for delivery on the Internet (TEENCOPE). This innovative modality for behavioral interventions can improve outcomes during adolescence, a vulnerable developmental stage, and has the potential to reduce long-term disease-related psychological and physiological complications.
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