Advancing Behavioral Research in Diabetes Care

Texas Children’s Diabetes and Endocrine Care Center is dedicated not only to preventing sequelae of diabetes but also to helping children and adolescents live well with this condition. Ashley Butler, PhD, associate professor of pediatric psychology, and Marisa Hilliard, PhD, ​​​​associate professor of pediatrics, have dedicated their careers to this goal. Dr. Butler leads the Health Disparities Lab and Dr. Hilliard leads the Resilience and Diabetes (RAD) Lab in the Division of Psychology. ​They each​ collaborate closely with the Division of Pediatric Diabetes and Endocrinology. 

“Our goal is to conduct research about ways to help people with diabetes to live long, happy, healthy and satisfying lives, even with a complex and demanding chronic condition,” said Dr. Hilliard. “Managing diabetes is not only about insulin regimens and glucose levels and devices but also about how all of that fits in the context of the rest of your life.” 

Drs. Butler and Hilliard have embarked on several research projects with this aim in mind.  

Advancing equity in care 

Dr. Butler’s Health Disparities Lab focuses on the need to find solutions to the well-documented inequities in diabetes outcomes. ​Her lab’s team has​​ published papers that look at existing evidence to find best practices for communities that have been marginalized by the health care system. 

“Before we develop services or programs, we take a step back to hear from families and patients — children, adolescents, young adults — and understand their needs, know what they think is helpful and understand what existing resources are already in their environment,” said Dr. Butler.  

Even small clinics could benefit from supporting someone on staff, such as a diabetes educator or a social worker, who can allow families to comfortably offer their opinions about ways to enhance services or programs. This level of community involvement is reflected in the way Texas Children’s operates both in clinical practice and research.  

“We value having diversity on our research teams,” said Dr. Hilliard. “We want to make sure youth and families feel represented, seen, welcome, understood — to make people feel like they are not just a subject of research but really a part of research and that our research is meeting their needs.” 

Building support for families from marginalized groups 

Between 2017 and 2021, Dr. Butler ran an NIH-funded pilot program to see if a new group-based intervention ​benefited and was acceptable​​ to African American and Hispanic families who were supporting a child with type 1 diabetes. Dr. Hilliard collaborated on this work. They focused on families with young school-aged children ​​​​so that any benefit offered to these families would lay the groundwork for healthy outcomes before they transitioned to adolescence.  

Drs. Butler and Hilliard were encouraged to see that families who participated in group sessions were able to build a network of support and showed improvements in emotional well-being. 

“We learned that delivering a program that connects parents who have a child with type 1 diabetes was really favorable. They describe really connecting with the other parents and some of them even describe feeling like they would have established a long-term relationship with other families,” said Dr. Butler.  

Building diabetes strengths 

Dr. Hilliard’s RAD Lab conducts research that focuses on supporting diabetes resilience and building individual, family, and community strengths to achieve positive diabetes outcomes.  

“The goal of the research is to help youth and young adults manage all of the challenges of living with diabetes, navigate the complex health care system and have both good quality of life and in-range glycemic outcomes,” said Dr. Hilliard.  

One of her current NIH-funded grants is testing a program in which peer mentors help young adults transition away from their pediatric endocrinology team to an adult provider. They’ve trained peer mentors to be a source of accountability, resources, encouragement, information and support to young adults with diabetes and help them navigate challenges in the health care system. ​The lab is investigating​​ whether one year of ​p​​eer ​mentor support will help young adults get established in adult care sooner and have better glycemic and psychosocial outcomes.  

Drs. Butler and Hilliard are dedicated to advancing the field of behavioral science as it relates to children and adolescents with diabetes.  

“As psychologists and behavioral scientists, we are in a unique and important position to improve the overall well-being of a child and family, not just from a medical standpoint, but really helping that family reach their potential and have a full and happy life,” said Dr. Butler. 

Refer a patient to Texas Children’s Diabetes and Endocrinology through their online portal or by calling 832-822-2778. Learn more about the Health Disparities Lab and the RAD Lab.