This study evaluated the effectiveness of a 12-week psychoeducational group therapy program in improving mood and glycemic control in adults with diabetes and visual impairments. The participants made statistically significant gains in glycemic control, and there was a significant positive relationship between control and improvement in depression, but greater knowledge of diabetes self-care did not correlate with improved glycemic control.

Better diabetes management can be achieved by adding an explicit psychological component to diabetes treatment. Three cases are presented that illustrate how integrated assessment and psychotherapy can improve glucose control through three mechanisms: increasing patient acceptance of a disease state, enabling behavior change for self-care, and removing psychological barriers to disease control. Guidelines are suggested for standardized integration of psychology into diabetes care. The explicit treatment of psychological barriers to diabetes self-management would enhance standard medical practice, which normally relies on education to overcome treatment adherence problems.Diabetes mellitus, a chronic disease in which the body does not produce or properly use insulin, is one of the most prevalent and costly diseases known today. About 6% of the population in the United States has diabetes. It is the seventh leading cause of death in people in the United States, and currently there is no cure. Complications from diabetes include blindness, kidney disease, heart disease and stroke, nerve disease and amputations, and impotence. Health care and other costs directly related to diabetes treatment, as well as the costs of lost productivity, are about $92 billion per year. On average, persons with diabetes aged 18-64 years old lost 8.3 days per year from work as compared with 1.7 days for people without diabetes (American Diabetes Association [ADA], 1997a).Although diabetes can affect any individual, certain ethnic groups are at greater risk for both the disease and its subsequent complications. African Americans are 1.7 times more likely to have diabetes than non-Hispanic Whites (ADA, 1997a). African Americans are also approximately two times more likely than non-Hispanic Whites to suffer from diabetes-related blindness, lower limb amputations, and kidney disease. In Hispanic Americans, the prevalence of Type 2 diabetes is two to four times higher than in non-Hispanic Whites. In addition, complications from diabetes are major causes of death and morbidity in most Native CHRIS FEIFER received her doctorate in public health from the

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