6.4.0.0 Di­a­betes Dis­tress

Di­a­betes dis­tress (DD) is very com­mon and is dis­tinct from other psy­cho­log­i­cal dis­or­ders (193-195). DD refers to sig­nif­i­cant neg­a­tive psy­cho­log­i­cal re­ac­tions re­lat­ed to emo­tion­al bur­dens and wor­ries specific to an in­di­vid­u­al’s ex­pe­ri­ence in hav­ing to man­age a se­vere, com­pli­cat­ed, and de­mand­ing chron­ic dis­ease such as di­a­betes (194-196). The con­stant be­hav­ioral de­mands (med­i­ca­tion dos­ing, fre­quen­cy, and titra­tion; mon­i­tor­ing blood glu­cose, food in­take, eat­ing pat­terns, and phys­i­cal ac­tiv­i­ty) of di­a­betes self-‍man­age­ment and the po­ten­tial or ac­tu­al­i­ty of dis­ease pro­gres­sion are di­rect­ly as­so­ci­at­ed with re­ports of DD (194). The preva­lence of DD is re­port­ed to be 18–45% with an in­ci­dence of 38–48% over 18 months (196). In the sec­ond Di­a­betes At­ti­tudes, Wish­es and Needs (DAWN2) study, significant DD was re­port­ed by 45% of the par­tic­i­pants, but only 24% re­port­ed that their health care teams asked them how di­a­betes af­fected their lives (193). High lev­els of DD significant­ly im­pact med­i­ca­tion tak­ing be­hav­iors and are linked to high­er A1C, lower self-‍efficacy, and poor­er di­etary and ex­er­cise be­hav­iors (17,194,196). DSMES has been shown to re­duce DD (17). It may be help­ful to pro­vide coun­sel­ing re­gard­ing ex­pect­ed di­a­betes-‍re­lat­ed ver­sus gen­er­alized psy­cho­log­i­cal dis­tress at di­ag­no­sis and when dis­ease state or treat­ment changes (197).

DD should be rou­tinely mon­i­tored (198) using pa­tient-‍ap­pro­pri­ate val­i­dated mea­sures (187). If DD is iden­tified, the per­son should be re­ferred for specific di­a­betes ed­u­ca­tion to ad­dress areas of di­a­betes self-‍care that are most rel­e­vant to the pa­tient and im­pact clin­i­cal man­age­ment. Peo­ple whose self-‍care re­mains im­paired after tai­lored di­a­betes ed­u­ca­tion should be re­ferred by their care team to a be­hav­ioral health pro­vider for eval­u­a­tion and treat­ment.

Other psy­choso­cial is­sues known to af­fect self-‍man­age­ment and health out­comes in­clude at­ti­tudes about the ill­ness, ex­pec­ta­tions for med­i­cal man­age­ment and out­comes, avail­able re­sources (finan­cial, so­cial, and emo­tion­al) (199), and psy­chi­atric his­to­ry. For ad­di­tional in­for­ma­tion on psy­chi­atric co­mor­bidities (de­pres­sion, anx­i­ety, dis­or­dered eat­ing, and se­ri­ous men­tal ill­ness), please refer to Sec­tion 4 “Com­pre­hen­sive Med­i­cal Eval­u­a­tion and As­sess­ment of Co­mor­bidi­ties.”