In the past couple of years, you or someone you know has likely faced fear, uncertainty, illness, or another challenging emotion or event as the world continues to live through the COVID-19 pandemic.

One skill that may be helpful in facing situations like these is resilience.

Resilience is the ability to bounce back from adversity and stress. “Resilience is a trait that we strive toward, rather than something we do or do not have,” says Marisa Hilliard, PhD, associate professor at Baylor College of Medicine and Texas Children’s Hospital and founder of Baylor’s Resilience and Diabetes Behavioral Research Lab in Houston.

There are many ways to build resilience, and for people managing a health condition such as diabetes, healthy routines can play an important role in times of stress, says Howard B.A. Baum, MD, endocrinologist and associate professor of medicine at Vanderbilt University in Nashville, Tennessee.

Building resilience can result in positive health effects like doing well with diabetes outcomes, such as A1C goals, time in target blood glucose range, or quality of life — despite all the challenges that life throws your way, says Dr. Hilliard.

Increasingly, researchers like Hilliard and Dr. Baum are identifying techniques and approaches to build resilience and to help people with diabetes live healthy and long lives.

The Effects of Resilience on Diabetes Outcomes

“Our studies try to identify the protective factors that people already have or can build to achieve better diabetes outcomes,” says Hilliard.

For example, a study published in July 2018 in Diabetes Care, which Hilliard led, involved more than 470 adolescents ages 10 to 19 with type 1 diabetes and found that strengths in managing diabetes, such as confidence in care or support from others, were associated with resilience. This resilience was linked with positive diabetes outcomes, such as regular blood glucose checks, a lower A1C, and a higher quality of life.

Joyce Yi-Frazier, PhD, senior clinical research scientist at Seattle Children’s Hospital in Washington, was among the first to explicitly study the role of resilience in diabetes management. In a study published in 2008 in the British Journal of Health Psychology, she and her colleagues found a strong association between rising distress and worsening A1C among people with low or moderate resilience. Those with high resilience did not show the same associations between distress and A1C. The study examined 111 people with type 1 or type 2 diabetes.

“Our research has shown that resilience and stress do impact diabetes management, quality of life, and A1C,” says Dr. Yi-Frazier, who now also studies resilience in other diseases such as cancer.

Another study by Yi-Frazier, published in Stress Health, consisted of 145 participants with type 1 or type 2 diabetes and found that individuals with adaptive coping strategies had higher resilience than people with maladaptive coping approaches, such as denial or anger.

A small study published in October 2020 in the International Journal of Behavioral Medicine enrolled 35 people with type 2 diabetes in a resilience-based education program that led to large increases in self-management behaviors and lower A1C readings after six months. Some of these same researchers are now leading a clinical trial that is funded by the National Institutes of Health to examine how resilience-specific diabetes education impacts the health outcomes of African Americans who are living with type 2 diabetes.

In Baum’s research, he has found that people with more routines for their diabetes management may be more resilient and adaptable, and thus have more favorable diabetes outcomes such as lower A1C. In a study published in October 2020 in Applied Ergonomics, Baum and his colleagues at Vanderbilt University interviewed 50 people with type 1 or type 2 diabetes and found that storing everyday objects such as blood glucose meters or insulin in accessible places anchored diabetes management routines and encouraged adherence.

5 Steps for Building Resilience When Living With Diabetes

“We have to be deliberate about our resilience,” says Yi-Frazier. “In other words, we need to spend the time to figure out how to shore up our resources that we need in times of stress.”

Sometimes, these resources are psychosocial and sometimes they are physical, practical routines. And either can help people better manage diabetes, say Hilliard and Baum.

Baum recommends identifying techniques that you know help you remember everyday details in your diabetes management. This could mean setting an alarm on your phone when you take medications or moving your insulin to the kitchen, so you take it during mealtimes.

It's undeniable that diabetes can be challenging, and the disease is associated with burnout and depression. Yet positive affect and strategic thinking can help build resilience. Hilliard shares the following tips:

1. Set Realistic Goals for Yourself

Focus on small achievable goals, such as walking a few days a week, rather than big goals that may be hard to achieve all at once.

2. Celebrate Your Successes

Recognize when you’ve met a small goal and then build on that change to reach larger goals in your diabetes management.

3. Show Gratitude

Gratitude means acknowledging what you’re grateful for and can involve expressing thanks. Practice this for yourself and others who help you manage diabetes. For example, be grateful in times that you’ve had a successful day, such as when you’ve met your diabetes management goals, or do it when you’ve had a challenging day such as stress at work — and then you still fit in, say, exercise.

4. Praise Yourself and Focus on Positive Actions Moving Forward

No one is going to do this for you, so it’s up to the person with diabetes to make this effort.

5. Recognize When You’re Struggling and Seek Help

A mental health professional such as a social worker or psychologist trained to help people with diabetes is ideal. The American Diabetes Association has a searchable directory of these specialists by area, and many offer telehealth.

Hilliard and Baum also point out that empathy and support, together from clinicians, caregivers, and people with diabetes themselves, are empowering.

Even during the pandemic and the growing mental health crisis in America, says Hilliard: “Many people with diabetes have been able to show resilience and do well with their diabetes management despite the numerous stresses in our world.”

Read more about practicing resilience while living with diabetes in Diabetes Daily's article, "Diabetes and the Fear It Creates."

How Resilience Can Help You Manage Diabetes (and How to Build It)