Richard Samuel Surwit

Professor Emeritus in Psychiatry and Behavioral Sciences

Education & Training

  • Ph.D., McGill University (Canada)

  • B.A., Earlham College

Overview

Our research program is focused the role of stress, depression and personality variables in the etiology and treatment of diabetes mellitus. We have recently finished a large clinical trial of stress-management in the treatment of type 2 diabetes that demonstrated that a brief, group, stress management intervention can improve long-term glycemic control in a large sample of patients with type 2 diabetes. In addition we have two other projects currently ongoing. The first is concerned with the impact of a cognitive behavioral program in the treatment of diabetes. Extensive literature documents increased incidence of depression in patients with diabetes mellitus. However, the degree to which the treatment of depression impacts on diabetes control is not clear. Some investigators have found a strong association between depression and diabetes control, while others have found a week assocation. A review of existing literature as well as preliminary data from our laboratory suggest that this discrepancy may be due, in part from failure of many studies to clearly differentiate type 1 and type type 2 diabetes in their patient samples. The strongest association between depression and diabetes control has been reported in studies of patients with type 1 diabetes. Preliminary data from our group suggests that the Beck Depression Inventory (BDI) scores may be more significantly related to hemoglobin A1c (HbA1c) in type 1, than in type 2, diabetes mellitus. Studies assessing the effects of pharmacologic antidepressant therapy on diabetes have been confounded by the combined use of both diagnostic categories as well as by the direct metabolic effects of most anitidepressant drugs. An emerging literature on the use of Cognitive Behavior Therapy (CBT) suggests that improving affect through behavioral intervention can improve diabetes control, particularly in type 1 patients. The overall aim of this project is to determine if CBT differentially improves glucose control in type 1 and type 2 diabetes patients. We hypothesize that CBT will produce a greater reduction in HbA1c in type 1 diabetes than in type 2 diabetes and that CBT-induced improvement in HbA1c is mediated by an improvement in depression. We will measure the effects of CBT on changes in HbA1c and daily blood glucose in a sample of 150 depressed patients with type 1 and type 2 diabetes over one year. To evaluate the mechanism by which CBT-induced changes in depression affect blood glucose, we will determine the role of cortisol and the role of diabetes self-care behaviors as mediating variables. Changes in cortisol and self-care are predicated to impact blood glucose levels to a greater extent in type 1 diabetes because these individuals are metabolically more sensitive to any variation.

The second major focus of our research program is to evaluate whether the apparent differential relationship between the personality construct of hostility and glucose metabolism in blacks and whites might contribute to the racial disparity in the prevalence of 2 diabetes. African-Americans are at increased risk for developing type 2 diabetes, but the reasons for this racial disparity are poorly understood. We are exploring our previous finding of a differential relationship of hostility to glucose metabolism in African-Americans and Caucasians and determine the underlying behavioral and/or physiologic mechanisms of these relationships. Two studies are being undertaken. First, we are assessing the multi-factorial nature of hostility in 100 African American men, 100 African American women, 100 Caucasian men, and 100 Caucasian women. These measures will be examined in relation to fasting and two-hour post-prandial glucose and insulin and hemoglobin A1c (HbA1c) on all subjects. This study should allow us to further understand the personality variables most directly related to glucose metabolism and to investigate the possibility that race and sex interact in determining this relationship. We also plan to further explore our preliminary findings that hostility is related to insulin sensitivity and elevated insulin levels in Caucasians and to fasting glucose in African-Americans. We will assess glucose-stimulated insulin release, glucose disposal, hepatic glucose production and glucose effectiveness utilizing an intravenous glucose tolerance test with labeled glucose in a subset of our sample. In addition, three sets of mediators will be examined: measures of hypothalamic-pituitary-adrenal (HPA) axis activity, measures of body mass and fat distribution, and measures caloric intake and exercise habits. It is hypothesized that hostility is related to diminished insulin sensitivity, but not to a defect in insulin secretion in Caucasians and that this relationship is mediated by BMI and the behavioral variables that impact on BMI. Furthermore, we hypothesize that hostility is related to increased hepatic glucose production and diminished insulin secretion in African-Americans and these relationships are mediated by neuroendocrine factors, but not by BMI. Confirmation of this hypothesis would confirm that African-Americans are more vulnerable to the metabolic effects of hostility and could partially explain the racial disparity in diabetes prevalence.

Finally, our laboratory continues to work on defining the mechanisms by which the C57BL/6J (B6) mouse develops diet-induced obesity and diabetes. This mouse will remain lean and euglycemic if it is raised on a low fat diet. However, when allowed access to a high fat diet, the B6 mouse will become obese and develop an analog of type 2 diabetes, even if caloric intake is matched to that of mice reared on a low fat diet.

Merwin, RM, Dmitrieva, NO, Honeycutt, LK, Moskovich, AA, Lane, JD, Zucker, NL, Surwit, RS, Feinglos, M, and Kuo, J. "Momentary Predictors of Insulin Restriction Among Adults With Type 1 Diabetes and Eating Disorder Symptomatology." Diabetes care 38.11 (November 2015): 2025-2032. Full Text

Boyle, SH, Georgiades, A, Brummett, BH, Barefoot, JC, Siegler, IC, Matson, WR, Kuhn, CM, Grichnik, K, Stafford-Smith, M, Williams, RB, Kaddurah-Daouk, R, and Surwit, RS. "Associations between central nervous system serotonin, fasting glucose, and hostility in African American females." Annals of behavioral medicine : a publication of the Society of Behavioral Medicine 49.1 (February 2015): 49-57. Full Text

Boyle, SH, Georgiades, A, Brummett, BH, Barefoot, JC, Siegler, IC, Matson, WR, Kuhn, CM, Grichnik, K, Stafford-Smith, M, Williams, RB, Kaddurah-Daouk, R, and Surwit, RS. "Associations between Central Nervous System Serotonin, Fasting Glucose, and Hostility in African American Females." Annals of Behavioral Medicine 49.1 (2015): 49-57. Full Text

Merwin, RM, Moskovich, AA, Dmitrieva, NO, Pieper, CF, Honeycutt, LK, Zucker, NL, Surwit, RS, and Buhi, L. "Disinhibited eating and weight-related insulin mismanagement among individuals with type 1 diabetes." Appetite 81 (October 2014): 123-130. Full Text

Feinglos, MN, Gibb, RD, Ramsey, DL, Surwit, RS, and McRorie, JW. "Psyllium improves glycemic control in patients with type-2 diabetes mellitus." Bioactive Carbohydrates and Dietary Fibre 1.2 (2013): 156-161. Full Text

Lane, JD, Lane, AJ, Surwit, RS, Kuhn, CM, and Feinglos, MN. "Pilot Study of Caffeine Abstinence for Control of Chronic Glucose in Type 2 Diabetes." J Caffeine Res 2.1 (May 24, 2012): 45-47. Full Text

Surwit, RS, Williams, RB, Lane, JD, Boyle, SH, Brummett, BH, Siegler, IC, Barefoot, JC, Kuhn, CM, and Gerogiades, A. "EPINEPHRINE, TRUNK FAT AND FASTING GLUCOSE." ANNALS OF BEHAVIORAL MEDICINE 43 (April 2012): S155-S155.

Brummett, BH, Babyak, MB, Siegler, IC, Surwit, R, Georgiades, A, Boyle, SH, and Williams, RB. "Systolic blood pressure and adiposity: examination by race and gender in a nationally representative sample of young adults." Am J Hypertens 25.2 (February 2012): 140-144. Full Text

Williams, RB, Surwit, RS, Siegler, IC, Ashley-Koch, AE, Collins, AL, Helms, MJ, Georgiades, A, Boyle, SH, Brummett, BH, Barefoot, JC, Grichnik, K, Stafford-Smith, M, and Kuhn, CM. "Central nervous system serotonin and clustering of hostility, psychosocial, metabolic, and cardiovascular endophenotypes in men." Psychosom Med 72.7 (September 2010): 601-607. Full Text

Surwit, RS, Williams, RB, Lane, JD, Feinglos, MN, Kuhn, CM, and Georgiades, A. "Plasma epinephrine predicts fasting glucose in centrally obese African-American women." Obesity (Silver Spring) 18.9 (September 2010): 1683-1687. Full Text

Pages

Georgiades, A, Brummett, BH, Siegler, IC, Surwit, RS, Kuhn, C, Grichnik, K, Stafford-Smith, M, and Williams, RB. "EFFECT OF CENTRAL NERVOUS SYSTEM SEROTONIN FUNCTION ON INFLAMMATION, ADIPOSITY AND INSULIN SENSITIVITY." April 2013.

Lane, JD, Kuhn, CM, Surwit, RS, Siegler, IC, Brummett, BH, and Williams, RB. "BLOOD PRESSURE 'NON-DIPPING' STATUS IS ASSOCIATED WITH GREATER OVERNIGHT EPINEPHRINE EXCRETION." April 2013.

Surwit, RS, Williams, RB, and Georgiades, A. "Adrenal Medullary Function, Adiposity and Fasting Glucose." November 2011.

Georgiades, A, Williams, RB, Lane, JD, Boyle, SH, Brummett, BH, Siegler, IC, Barefoot, JC, Kuhn, CM, and Surwit, RS. "Plasma Epinephrine Levels Determine Fasting and Stress Induced Glucose Levels in Women With High Central Adiposity." November 2009.

Surwit, RS, Kuhn, CM, Helms, MJ, Siegler, IC, Feinglos, MN, and Williams, RB. "MAO-uVNTR is related to CNS serotonergic function, glucose metabolism, BMI, and hostility." June 2006.

Kuhn, CM, Gadde, K, Schanberg, SM, Marchuk, DA, Siegler, IC, Surwit, RS, and Williams, RB. "Serotonin transporter polymorphism influences the prolactin response to tryptophan and stress." December 2005.

Collins, S, Surwit, RS, Wang, SY, Daniel, KW, Petro, AE, and Snedden, SK. "Regulation of the uncoupling protein genes (UCP-1,-2,-3) by nutrients and hormones." 1999.

SURWIT, R, MCCASKILL, C, ROSS, S, and FEINGLOS, M. "BEHAVIORAL AND PHARMACOLOGICAL MANIPULATION OF GLUCOSE-TOLERANCE IN TYPE-II DIABETES." 1991.

SURWIT, R, ROSS, S, and FEINGLOS, M. "STRESS, BEHAVIOR, AND GLUCOSE CONTROL IN DIABETES-MELLITUS." 1991.

Eating Disorders in Type 1 Diabetes: Mechanisms of Comorbidity awarded by National Institutes of Health (Co Investigator). 2011 to 2015

IPA - John Curry awarded by Veterans Administration Medical Center (Principal Investigator). 2013 to 2014

IPA - John Curry awarded by Veterans Administration Medical Center (Principal Investigator). 2011 to 2012

Prospective Effects of Pychosocial Factors on Bariatric Surgical Success awarded by National Institutes of Health (Principal Investigator). 2009 to 2012

Stress and Behavior in Health and Disease awarded by National Institutes of Health (Mentor). 1989 to 2011

Training in Psychological Intervention Research awarded by National Institutes of Health (Training Faculty). 2006 to 2011

Novel Group Parent Training Program for Anorexia Nervosa awarded by National Institutes of Health (Consultant). 2005 to 2010

Caffeine and Glucose Regulation awarded by National Institutes of Health (Co Investigator). 2004 to 2010

Hostility, Race, and Glucose Metabolism awarded by National Institutes of Health (Principal Investigator). 2003 to 2009

Surveillance And Analysis Of The UNC Alumni Heart Study awarded by National Institutes of Health (Co Investigator). 1996 to 2007

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