Diabetes distress

Abstract

Living with diabetes is demanding and often frustrating when blood glucose levels remain stubbornly out of target despite an individual’s best efforts. With no holidays from diabetes, it is perhaps little wonder that more than a half of those living with diabetes develop a constellation of psychological symptoms known as diabetes distress in response to the relentless burden of the disease. Symptoms include: anxiety about the future and the possibility of serious complications; feeling guilty or anxious when the diabetes management goes awry; and feeling scared, discouraged or depressed when thinking about living with diabetes and its management. First recognized over 25 years ago, it has become clear that diabetes distress not only adversely affects the psychological well-being of people with diabetes, but also their ability to manage the diabetes effectively. Despite a growing awareness of the need to address the psychological needs of people with diabetes and a deeper understanding of the effects of diabetes distress, the research has not been translated into everyday clinical practice, in part because many healthcare professionals lack the confidence and skills to raise the subject. A practical guide is needed, and this month we publish just such an article from three giants in the field, Larry Fisher, Bill Polonksy and Danielle Hessler [1]. The review covers five areas, beginning with a definition of diabetes distress, before moving on to the ways diabetes distress can be assessed and monitored, what clinicians need to know to plan interventions to manage diabetes distress, and finally what interventions are effective and when they should be used. Stahl-Pehe et al. [2] discuss the correlates and effect of diabetes distress in another article in this month’s issue. Studying a national cohort of adults with early-onset Type 1 diabetes, the authors found higher rates of distress in women, those with lower socio-economic status and those with depressive symptoms. Diabetes distress was also associated with poorer physical and mental health, higher HbA1c levels and less satisfactionwith diabetes care. The study also reported how higher baseline distress was associated with worse glycaemic control 3 years later and poorer mental health. It is clearly important that the advice from Fisher et al. is implemented in daily clinical practice in order to prevent the problems described by Stahl-Pehe et al. In December 2016, the Steno Diabetes Centre convened an international Diabetes Self-Management Alliance meeting in Copenhagen to address how psychosocial support could be integrated into routine diabetes care. Joensen et al. [3] report the deliberations of the meeting. The challenges and solutions lie in the relationships between people with diabetes and their healthcare professionals, the healthcare system and the wider community. The participants recognized that lack of time to address psychosocial issues was a major barrier; at present, this is a low priority and so to redress this imbalance, we need to move away from purely biomedical measures of productivity in healthcare systems to allow greater attention to mental wellbeing. Providing appropriate incentives and resources to healthcare professionals may allow healthcare professionals to dedicate more time to this aspect of care; however, societal attitudes need to change to persuade payers to make the necessary changes in service configuration and help overcome the stigma and blame experienced by people with diabetes.