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Is emotional support nearly as important as diabetes medication? See why one diabetes specialist says yes.

We enjoyed chatting with Michelle, an assistant professor and research scientist at the University of Utah College of Nursing, as well as a board-certified family nurse practitioner who works with adults with type 1 and type 2 diabetes. She talked with us about the value of peers providing diabetes support to one another, and how she helps her patients connect.

How did you choose to specialize in diabetes care?

I always knew I didn't want to be in a quick-fix area of healthcare—I wanted to get to know patients better. Initially, I was concentrating on forensic nursing, but then I had an endocrinology rotation and it completely changed my focus. I realized how hard people with diabetes were working, how they were doing their best and not getting credit for it. There's so much attention paid to negative statistics, but not a lot of notice is given to those who are working so hard to manage their diabetes.

When I graduated, I had an opportunity to work at an endocrinology clinic, and that was it. I haven’t looked back since.

How did your interest in peer support come about?

I was working with a 19-year-old patient with type 1 diabetes, and they told me that they felt isolated. They'd never been to camp and hadn't had opportunities to connect. I thought, "I know hundreds of people you could relate to," but due to the HIPAA privacy rule, I couldn't connect them.

But you found a way.

I realized quickly the importance of knowing another person you can connect to when managing a chronic condition. I work with adults, so even those who had gone to camp as kids may not have those connections anymore. I was also caring for many people who were diagnosed as adults, and did not have the opportunity to attend diabetes camps. So a colleague and I developed the first Diabetes Mixer. We invited people with type 1 diabetes who were 18 to 30 years old to come to a restaurant. There was live music, speakers, and free food—we worked with the chef to figure out the carb counts. It was like any other party, but everyone had this shared connection related to type 1 diabetes. Over time, word got around and people over age 30 wanted to come, too, so we took off the "under 30" limit.

At the Utah Diabetes and Endocrinology Center, our team started a Diabetes One-Day Education and Care program with separate sessions for people with type 1 and type 2 diabetes. Everyone gets together in small-group settings in a hybrid diabetes education and shared medical visit program. It's not just an educator talking—they're there to support one another. It's been really helpful—we've had people come in who were distressed who feel understood based on the shared experiences of others. We've had people with type 2 diabetes help each other over concerns with starting insulin. People often don't realize they need peer support until they receive that support and are able to reflect back.

When did you start to incorporate online support into your research?

I met a really active member of the diabetes online community—he'd started a YouTube channel with stories about his own experience, so we had him speak at a Diabetes Mixer. That's when it became clear to me how valuable online communities can be.

Don't you have concerns about people seeking health information online?

I think a lot of healthcare providers might be surprised at how much online communities can help. There is a difference between a Web-based search and a search within an online community of people with a similar condition. In a community, there are people who can help provide experiential information as well as evidence from the latest research. In fact, I'm working on a study right now that suggests that the prevalence of misinformation is quite low in a community setting, and what may be incorrect is self-policed and usually pretty benign.

Diabetes management takes a whole team, and healthcare providers are just one part. Family, friends and peers all have important contributions to make.

So, what's next for you?

Right now, I'm exploring whether online peer support should be prescribed, just like medication. After all, knowing that diabetes and depression often go hand-in-hand, the mental health benefits of feeling connected can be just as important as medicine. Feeling emotionally supported is absolutely invaluable.

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