The Mental and Emotional Concerns That Often Accompany Diabetes

A year ago, the American Diabetes Association (ADA) released, for the first time, guidelines for the psychosocial care of people with type 1 and 2 diabetes.

The guidelines focus on common psychological issues that many people with diabetes will recognize, such as diabetes distress, anxiety, depression, eating disorders, and the difficulties of daily diabetes self-management.

Knowing what the ADA’s guidelines cover may reassure individuals struggling with these issues that their concerns are real, shared by many, and with the right help can be relieved or remedied.

The Guidelines

The recommendations, put together by the Deborah Young-Hyman, Ph.D. and colleagues, state that:

  • Co-occurring psychological issues need to be assessed, and addressed. Many people with diabetes also suffer from depression, or anxiety disorders that interfere with their capacity for good diabetes self-care. A 2016 study, for instance, showed that having depression contributed to negative psychiatric and medical outcomes in adults with type 2 diabetes.
  • Data also indicates about 19.5 percent of those with type 1 and 2 diabetes experience generalized anxiety disorder. These individuals may fear having high or low blood sugar, be frightened by insulin injections, infusions, or diabetes complications, or may worry constantly about not meeting their glucose targets.
  • The new ADA guidelines highly recommend annual depression and anxiety screenings for diabetes patients. Those who meet the criteria for a diagnosis of either psychological condition should be referred to mental health professionals for further assessment and treatment. Also, individuals with anxiety owed to severe low blood sugar episodes should be evaluated for hypoglycemia unawareness.
  • Disordered eating issues need to be evaluated. A high rate of eating disorders occur in people with type 1 and 2 diabetes; common symptoms are binge eating, or skipping insulin injections to lose weight.
  • The new ADA guidelines suggest 1) an evaluation of treatment regimens for diabetes patients with disordered eating behaviors, and 2) eating disorder screenings when weight loss and high blood sugar cannot be explained by medication, dietary, or physical activity changes.
  • "Life course" factors need to be considered. The new ADA guidelines note that people are being diagnosed with diabetes earlier in life, and are living longer.
  • Therefore, health care providers are recommended to consider a patient’s lifestyle and emotional status when determining which resources will maximize their disease outcomes, and longterm well being.
  • Psychosocial care deficits need to be addressed. The new ADA guidelines recognize a need for more mental health clinicians who are knowledgeable about managing, and living with diabetes.
  • “While medical providers are trained to help people manage the medical aspects of their disease, they are not always taught to understand the impact that psychosocial factors have on people living with diabetes,” said Alicia McAuliffe-Fogarty, Ph.D., clinical health psychologist and ADA’s lifestyle management team vice-president.
  • The ADA and the American Psychological Association will be implementing a training curriculum for mental health clinicians to ameliorate this diabetes care deficit.

The ADA's guidelines are meant to create both immediate and ongoing psychosocial support for individuals with diabetes, but those currently in need of such support may still have to seek it out.

People struggling with the daily self-management of diabetes because of mental, or emotional matters are recommended to be “squeaky wheels.” Keep talking to doctors, diabetes educators, mental health counselors, support groups, family, or friends until you find the help needed.

Source: Endocrinology Advisor
Photo credit: Alon

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