CHRONIC DISEASE SELF-
MANAGEMENT LAB
Current Projects and Collaborations
The primary focus of the lab is on research to improve our understanding of successful self-management of type 1 and type 2 diabetes and the development of interventions to improve self-management, health and quality of life outcomes in patients. However, we are also involved in related work in other chronic illnesses, such as epilepsy and HIV/AIDS. Below is a summary of select ongoing projects.
JDRF Study - Telemedicine-Delivered Cognitive Behavioral Therapy to Reduce Diabetes Distress in Young Adults with Type 1 Diabetes (CBT-DD)
Not many studies have specifically targeted diabetes distress in young adults with this disease, and it remains unknown whether interventions can positively impact blood-sugar management in this population. This New York City-based study will utilize telemedicine to deliver cognitive behavioral therapy to young adults with T1D to reduce diabetes-related distress. The study will recruit 150 young adults nationally, aged 18 to 30, to evaluate whether telemedicine-delivered cognitive behavioral therapy, plus continuous glucose monitor (CGM), will yield significant improvement in both diabetes distress and blood-sugar control, compared with CGM alone—which has become the current standard of T1D care. Recruitment efforts will include young adults from non-Hispanic Black and Hispanic backgrounds who may be primarily Spanish-speaking to demonstrate the reach of the approach to underserved communities.
The Glycemia Reduction Approaches in Diabetes: A Comparative Effectiveness Study (GRADE)
GRADE is a longitudinal multi-site study comparing the effectiveness of four commonly used glucose lowering medications when combined with metformin. The goal of the GRADE study is to identify which combination of diabetes medications results in the following: optimal glycemic control, minimal side effects, and overall health in long-term treatment for individuals with Type 2 Diabetes. Fourty-five sites across the United States, including Albert Einstein College of Medicine, are enrolling and following participants for 7 years. A sub study of the GRADE trial will specifically assess emotional distress, depressive symptoms, and diabetes distress. Factors including self-care, neuroendocrine levels, self-efficacy and beliefs about medication will be evaluated.
Function and Emotion in Everyday Life with Type 1
Diabetes (FEEL-T1D) Study
FEEL-T1D is a multi-site study that aims to further our understanding of how blood sugar levels are related to emotional wellbeing and ability to do everyday activities among adults with type 1 diabetes. This study incorporates continuous glucose monitoring (CGM), ecological momentary assessment (EMA), and accelerometer data to assess short-term dynamic relationships among blood glucose, function (including physical activity and cognitive performance), and emotional distress . This knowledge will provide insights that underpin future clinical, technological, and psychosocial innovations to enhance the health and well-being of adults with T1D.
Our Collaborators
Dr. Gonzalez serves as the director of the New York Regional Center for Diabetes Translation Research, which was designed to increase collaboration among investigators across multiple disciplines.
The study team, which is composed of interdisciplinary researchers and healthcare workers, assess risk factors and mobility, cognitive, and behavioral changes associated with the aging brain.
This is an epidemiological multi-center study that assessed prevalence and development of disease in order to identify risk factors within Hispanics/Latinos.
Division Chief, Endocrinology
Professor, Department of Medicine (Endocrinology)
Jacob A. and Jeanne E. Barkey
Chair in Medicine
Assistant Professor, Department of Medicine (Endocrinology)
Director, Supporting Emerging Adults with Diabetes program (SEAD)
Director of Psychology, Fleischer Institute for Diabetes & Metabolism
Assistant Professor, Department of Medicine (Endocrinology)
Assistant Professor, Department of Psychiatry and Behavioral Sciences
Past Projects
Emotional Distress, Depression, and Diabetes Self-Management
Several ongoing studies focus on comparing approaches to the measurement of diabetes-related distress and depression in adults with diabetes. Other recent works have focused on the buffering effect of social support on distress and disease burden in diabetes, how patient's can be helped to develop a sense of illness coherence through self-management practices, the relationship between risk perception, illness beliefs and self care, as well as the implications of family history of diabetes for illness beliefs and distress/depression. Newer areas of interest include the influence of personality and neuropsychological functioning on distress and medication adherence, and relationships between beliefs about insulin, eating attitudes and insulin adherence.
Neurobehavioral and Psychosocial Aspects of Treatment Adherence and Quality of Life in Epilepsy
Dr. Gonzalez is a co-investigator on a preliminary project, led by Dr. Luba Nakhutina, at the SUNY Downstate Comprehensive Epilepsy Center, which aims to identify neurocognitive, emotional, and behavioral factors associated with treatment adherence and quality of life in medically refractory adults with epilepsy.
Interventions for Depression and Distress in Diabetes
Dr. Gonzalez worked closely with Dr. Steven Safren and colleagues at the Massachusetts General Hospital and Harvard Medical School on the development and evaluation of an integrative approach to addressing the related problems of treatment nonadherence and depression in adults living with chronic illness. This approach, Cognitive Behavioral Therapy for Adherence and Depression (CBT-AD), has recently been successfully applied in an efficacy evaluation with depressed adults with sub-optimally controlled type 2 diabetes. Ongoing qualitative and quantitative research seeks to adapt this approach for use within our ethnically diverse population of patients in the Bronx to improve the management of diabetes and diabetes-related emotional distress.
Telephonic Diabetes Self-Management Support in Primary Care
Dr. Gonzalez was awarded a 5-year R18 grant from the National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health (NIH). This project involved a close collaboration with the New York City Department of Health and Mental Hygiene (NYC DOHMH) and co-investigators at the Diabetes Research Center at Albert Einstein College of Medicine. We conducted an effectiveness evaluation of a behavioral intervention to improve type 2 diabetes self-management, reduce levels of emotional distress, and improve control of blood sugars, blood pressure, and cholesterol. The intervention built on a health-educator-delivered, telephone-based approach to support diabetes self-management, developed by Dr. Elizabeth Walker (Co-Investigator). The intervention components aimed at improving emotional distress. The intervention was implemented in various NYC primary care practices, through our partnership with the NYC DOHMH Primary Care Information Project (PCIP). Dr. Winfred Wu (Co-PI), Director of Public Health Informatics within the PCIP worked with Dr. Gonzalez to implement the program in a manner that was cost-effective, sustainable, and had the potential for widespread dissemination.
Adolescents with Type 1 Diabetes
We also have interests in extending our work to type 1 diabetes in pediatric populations. In collaboration with Dr. Rubina Heptulla, Chief of The Division of Pediatric Endocrinology and Diabetes at The Children's Hospital at Montefiore, our lab has recently completed a study exploring the concepts of illness identity, self-perception, and peer relationships in adolescents with Type 1 Diabetes. Using both qualitative and quantitative methodology, we have combined previously researched concepts to explore a new relationship prevalent in adolescence: how perception of the self with diabetes is bidirectionally related to peer relationships, and how this combination of illness identity and peer support effects self-care and treatment adherence. Additionally, we have recently begun recruitment for a second study at the Children's Hospital at Montefiore in collaboration with Dr. Deidre Edwards, a psychologist in the Pediatric Endocrinology and Diabetes clinic. This study will focus on the relationships among illness specific self-esteem, psychosocial variables, and disease outcomes in adolescents with Type 1 Diabetes.
Assessment and Perspectives of Medication Adherence Measurement in Type 2 Diabetes
This study explores the patient’s approach to filling out medication self-report surveys, while qualitatively exploring the link between diabetes-specific distress and adherence. This study combines quantitative and qualitative methods to interview adult patients with type 2 diabetes regarding how they interpret and report medication-taking behavior. The major objectives of the proposed study are to explore how patients answer questionnaires about medication adherence and improve how diabetes-specific medication questionnaires are written. Additionally, the study strives to explore patients’ cognizance of the connection between diabetes specific distress and medication adherence.This study will help to elucidate the factors patients associate with taking medication, how patients arrive at their estimations and patients’ understanding of the terminology used in self-report measures.