Scientists awarded $2.4 million to research potential behavioral treatment in prediabetic individuals

Warren Bickel

Jim Stroup

Warren Bickel directs the Addiction Recovery Research Center at the Virginia Tech Carilion Research Institute.

Editor's note (Updated on May 23, 2017): Researchers are actively recruiting prediabetic individuals for this project. Learn more about participating in this study by clicking here.

Warren Bickel, a professor at the Virginia Tech Carilion Research Institute, recently received a $2.4 million grant to investigate and improve maladaptive decision-making that may contribute to Type 2 diabetes.

The grant was awarded by the National Institute of Diabetes and Digestive and Kidney Diseases at the National Institutes of Health. The co-principal investigator on the grant, Leonard H. Epstein, is a State University of New York distinguished professor of pediatrics in the Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo.

“Behavior is one of the biggest challenges in health care,” said Bickel, who is also the director of the Virginia Tech Carilion Research Institute’s Addiction Recovery Research Center. “Obesity, risk-taking, and addiction are all chronic behavioral issues that are difficult to change.”

Bickel and Epstein both study decision-making, with an emphasis on health behavior. Bickel has found that those with addiction tend to discount the future – the further away an event, the less they value it.

The researchers will apply approaches they have developed in their independent work to study how people on the brink of developing Type 2 diabetes value the future.

“There are extremely high rates of Type 2 diabetes among obese individuals, and we might be able to help lower those rates,” Bickel said. “Obese people with Type 2 diabetes also tend to be less medically compliant, leading to further medical complications. We believe improving self-regulation might be the key to more efficacious treatment.”

Bickel’s research on future discounts combines with Epstein’s extensive work on understanding the molecular mechanisms that regulate the balance between calories consumed and calories used in the human body.

“While you would think everyone who is told they are at risk for diabetes would immediately initiate multiple behavior changes, it is hard to change behavior,” said Epstein, who is also the director of the Division of Behavioral Medicine in the Department of Pediatrics at the University at Buffalo. “One of the main challenges is the fact that many people with prediabetes will discount the future.”

The researchers might be able to help people improve their dietary decision-making and medical compliance by employing future-oriented thinking.

“This technique works like a charm in people with health behavior challenges, particularly smokers and obese individuals,” Bickel said. “We think it’ll help with prevention of Type 2 diabetes, as well.”

The solution may be for the individual to tag personal events in the future. If a person imagines important future events with detail – such as an upcoming wedding – and is then reminded of the events during mealtimes, the person will eat less. Asking people to participate in this future-oriented thinking makes the future feel more tangible, and more valuable. At least, that’s what Epstein’s group has found.

“In other studies, we’ve seen a novel shift in the interpretation of time,” Bickel said. “We believe that as people value the future more, they will smoke or drink less – or even stop their smoking or drinking altogether.”

For people addicted to food, however, it’s impossible to go cold turkey. Instead, Bickel and Epstein will consider a person to be in recovery once they improve their self-regulation when it comes to eating.

“People become trapped by the tyranny of small decisions,” Bickel said. “By targeting how people with prediabetes value the future, we might be able to improve self-regulation and help these individuals break through, to make and keep big decisions for their futures.”