With $2.4 million grant, UB researchers will study how self-regulation might help patients with pre-diabetes

BUFFALO, N.Y. — Researchers at the Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo and Virginia Tech Carilion Institute have been awarded a $2.4 million grant to study and improve maladaptive decision-making that may contribute to Type 2 diabetes. The hope is that behavioral techniques could help people with prediabetes overcome their focus on short-term rewards and develop healthier behaviors.

The grant was awarded to Leonard H. Epstein, PhD, SUNY Distinguished Professor in the Jacobs School of Medicine and Biomedical Sciences and director of the Division of Behavioral Medicine in the Department of Pediatrics as part of the Science of Behavior Change (SOBC) Initiative funded by the Common Fund of the National Institutes of Health (NIH) and by the National Institute of Diabetes and Digestive and Kidney Diseases at the NIH. The co-principal investigator on the grant, Warren Bickel, is professor and director of the Virginia Tech Carilion Research Institute’s Addiction Recovery Research Center.

Prediabetes represents an elevation of fasting blood glucose or glycated hemoglobin that will transition to Type 2 diabetes unless behavior changes are made, such as losing weight, improving dietary quality or being more physically active. Many people with a diagnosis of prediabetes will also have elevated blood pressure or blood lipids.

As Epstein notes, “While you would think that everyone who is told they are at risk for diabetes would immediately initiate multiple behavior changes, it is hard to change behavior, with one of the main challenges being the fact that many people with prediabetes will discount the future.”

Epstein and Bickel both study decision-making, with an emphasis on health behavior. The researchers will apply approaches they have developed in their independent work to study how people on the brink of developing Type 2 diabetes can be taught to be less impulsive and value the future.

Epstein hopes the researchers can help people improve their dietary decision-making and medical compliance by employing future-oriented thinking.

“Our recent research has demonstrated that many people have difficulty resisting the impulse for immediate gratification,” said Epstein, who directs the Division of Behavioral Medicine in the UB Department of Pediatrics. “They do something called delay discounting, in which they discount future rewards in favor of smaller, immediate rewards.

“But we have also found that people can be taught to postpone immediate gratification by visualizing a future reward through something we call episodic future thinking,” he said. “The overarching goal of this grant is to translate our research on delay discounting and episodic future thinking into powerful interventions that can prevent people with prediabetes from becoming diabetic.”

Teresa Quattrin, MD, UB Distinguished Professor and Chair of Pediatrics in the Jacobs School of Medicine and Biomedical Sciences at UB and pediatrician-in-chief at Women & Children's Hospital of Buffalo and Lucy D. Mastrandrea, MD, PhD, associate professor in the Department of Pediatrics , are co-investigators.