Diabetes Psychosocial Care Addressed by ADA in First Published Recommendations

The American Diabetes Association (ADA) has released a position statement focused on aspects of psychosocial care in type 1 and type 2 diabetes, published in Diabetes Care.¹ Based on current diabetes research and recommendations from mental and behavioral health professionals, these comprehensive guidelines are a first from the ADA.

Deborah Young-Hyman, PhD, of the Office of Behavioral and Social Science Research at the US National Institutes of Health (NIH) in Bethesda, Maryland, and colleagues authored the position statement, which focuses on “the most common psychological factors affecting people with type 1 and type 2 diabetes,” according to an ADA press release.²

“Providing care for the mental and physical health of people with diabetes simultaneously will improve both outcomes,” said Dr Young-Hyman in an email interview with Endocrinology Advisor. “It is not expected that any one clinician can provide all services. The biggest challenge is capacity: the need for more mental health providers who are knowledgeable about living with and managing the disease.”

Dr Young-Hyman added that topics were chosen based on a number of criteria: “The impact of psychosocial factors on people’s ability to manage the disease (ie, carry out self-management behaviors essential to achieving good outcomes); the prevalence of comorbid psychological conditions in the [type 1 and type 2 diabetes] populations; and the state of the evidence and expert opinion regarding standards of care and best practices.”

The guidelines focus on some of the most common psychological issues facing patients with diabetes: diabetes distress, depression, anxiety, and eating disorders. Additionally, the authors emphasize the role that self-management plays in successful care.

“Suboptimal self-management may be due to functional limitations (e.g., blindness, problems with dexterity, low health literacy and numeracy), lack of appropriate diabetes education…disruption of routines, or psychosocial barriers such as inadequate family and/or social support [or] misinformation,” the authors wrote, adding that clinicians caring for people with diabetes should evaluate patient needs on an individual basis to tailor solutions to specific problems.

“Providing care for the mental and physical health of people with diabetes simultaneously (integrated care) will improve both outcomes,” added Dr Young-Hyman when speaking with Endocrinology Advisor. “It is essential to put together a care team, with the patient at its center.”

Psychological Comorbidities

Clinically significant psychopathology in people with diabetes can interfere with a person’s ability to successfully carry out even basic self-management tasks. A 2016 study published in Diabetes Care revealed that in adults with type 2 diabetes, overall exposure to depression contributes to negative medical and psychiatric outcomes.³

Participants in this study experienced an average of 1.8 episodes of major depressive disorder (MDD) with a mean duration of 23.4 months. Although analysis showed that median episode duration and recovery time decreased with each subsequent episode, the clinical burden of MDD in type 2 diabetes indicates the need for “consistent and progressive treatment” to prevent adverse consequences.^3,4

Similarly, anxiety disorders — including generalized anxiety disorder, body dysmorphic disorder, and posttraumatic stress disorder — adversely affect people with type 1 and type 2 diabetes.¹ Review of behavioral Risk Factor Surveillance System data published in Diabetic Medicine revealed that the estimated prevalence of generalized anxiety disorder in people with type 1 or type 2 diabetes is 19.5%⁵; specific concerns include fears related to hyper- and hypoglycemia, not meeting blood glucose targets, fear of insulin injections or infusions, and complications.^1,6-9