832 DIABETES CARE, VOLUME 22, NUMBER 5, MAY 1999 I n the dualistic view of human nature that guides much of our thinking about health, many see the medical progress achieved with diabetes over the past decade as obviating the role of behavioral science. But in reality, improvements in medical care, such as intensive insulin regimens, require more patient counseling, educa- tion, and support than simpler regimens, such as “take one shot a day and watch the sweets.” Developments in biology, genetics, pharmacology, and medicine do not dimin- ish but rather expand the importance of behavioral science. An excellent demonstration of the role of behavioral science in diabetes care lies in the Diabetes Control and Complications Trial (DCCT) (1). The DCCT tested the efficacy of a coordinated, comprehensive approach to intensive diabetes manage- ment and tactics for teaching and motivat- ing patients to adhere to this approach (2,3). In this, it was extraordinarily suc- cessful. During the trial’s first year, adher- ence levels were 97% for visits completed according to protocol, 84–90% for self- monitoring of blood glucose (SMBG), 99% for completion of capillary blood collec- tions, and 96% for completion of end-of- year assessments of main study variables (4). Over the 6.5 years of the trial, 97% of participants were retained (1). Individualization of the intensive regi- men, ongoing staff support, and follow-up contact were central to the adherence the DCCT achieved (2,3). SMBG results, insulin management, and medical nutrition therapy were all pursued from a personal- ized, problem-solving approach (5). Throughout the trial, participants knew that a prestigious group of professionals was very interested in their care and avail- able by phone 24 hours a day. In response to a survey regarding their experiences, participants in the intensive therapy condi- tion reported 1.54 times the level of sup- port from staff as those in conventional treatment ( P  0.001) (6). Thus, the DCCT’s chief finding, that “metabolic control matters” (2,5) rested on its attention to behavioral factors in helping participants adhere to complex and demanding treatment regimens. The DCCT is just one example of the many contribu- tions behavioral science makes to diabetes care. It also illustrates a major point of con- cern. Although the DCCT effectively addressed behavioral issues, it did not ade- quately define or monitor the methods for doing so. Consequently, generalization and translation of its success is limited. As will be demonstrated, there are large gaps between the importance and potential of behavioral science in diabetes care and the attention and support it receives. Below, we review established behavioral science From AMC Cancer Research Center (R.E.G.), Denver, Colorado; Washington University (E.B.F.), St. Louis, Missouri; Joslin Diabetes Center (B.J.A.), Boston, Massachusetts; University of Miami (A.L.), Miami, Florida; Indiana University School of Medicine (D.M.), Indianapolis, Indiana; University of Florida Health Sciences Center (S.B.J.), Gainesville, Florida; Johns Hopkins University School of Medicine (R.R.R.), Baltimore, Mary- land; and University of Virginia (D.J.C.), Charlottesville, Virginia. Address correspondence and reprint requests to Russell E. Glasgow, PhD, AMC Cancer Research Center, 1600 Pierce St., Denver, CO 80214. E-mail: glasgowr@amc.org. Received for publication 24 June 1998 and accepted in revised form 20 January 1999. Abbreviations: ADA, American Diabetes Association; BGAT, Blood Glucose Awareness Training; CAL, computer-assisted learning; CDC, Centers for Disease Control and Prevention; CVD, cardiovascular disease; DCCT, Diabetes Control and Complications Trial; DPT-1, Diabetes Prevention Program for Type 1 Diabetes; DQIP, Diabetes Quality Improvement Project; GHb, glycosylated hemoglobin; NIDDK, National Institute of Diabetes and Digestive and Kidney Diseases; NIH, National Institutes of Health; SMBG, self-monitoring of blood glucose. A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances. Behavioral Science in Diabetes Contributions and opportunities OBJECTIVE — To summarize the current status of behavioral research and practice in dia- betes and to identify promising future directions. RESEARCH DESIGN AND METHODS — We review behavioral science contribu- tions to diabetes in self-management and patient empowerment, interventions with children and adolescents, and special problems including blood glucose awareness training and com- plications such as depression. We also identify emerging areas in which behavioral science stands to make significant contributions, including quality of life, worksite and community programs, interventions using new information technologies, and translation research evalu- ating practical programs in representative settings. We then discuss the gap between the gen- erally encouraging research on behavioral contributions to diabetes and the infrequent incorporation of such contributions in practice. Suggestions are made for how to close this gap, including ways to increase understanding of behavioral issues, opportunities for funding of key research and implementation questions, and how behavioral science principles can become more integrated into diabetes organizations and care. CONCLUSIONS — Changes are required on the part of behavioral scientists in how they organize and present their research and on the part of potential users of this knowledge, includ- ing other health professions, organizations, and funding agencies. Integrating behavioral sci- ence advances with other promising genetic, medical, nutritional, technology, health care, and policy opportunities promises not only to broaden our understanding of diabetes but also to improve patient care, quality of life, and public health for persons with diabetes. Diabetes Care 22:832–843, 1999 RUSSELL E. GLASGOW , PHD EDWIN B. FISHER, PHD BARBARA J. ANDERSON, PHD ANNETTE LAGRECA, PHD DAVID MARRERO, PHD SUZANNE B. JOHNSON, PHD RICHARD R. RUBIN, PHD DANIEL J. COX, PHD R E V I E W Reviews/Commentaries/Position Statements