2.6.0.0 Psychoso­cial Fac­tors

Rec­om­men­da­tions

13.97 Providers should as­sess so­cial con­text, in­clud­ing po­ten­tial food in­se­cu­ri­ty, hous­ing stabil­i­ty, and finan­cial bar­ri­ers, and apply that infor­mation to treat­ment de­ci­sions. E

13.98 Use pa­tient-‍ap­pro­pri­ate stan­dard­ized and val­i­dat­ed tools to as­sess for di­a­betes dis­tress and men­tal/be­hav­ioral health in youth with type 2 di­a­betes, with at­ten­tion to symp­toms of de­pres­sion and eat­ing dis­or­ders, and refer to spe­cialty care when in­di­cated. B

13.99 When choos­ing glu­cose-‍low­er­ing or other med­i­ca­tions for youth with over­weight/ obe­si­ty and type 2 di­a­betes, con­sid­er medication-tak­ing be­hav­ior and their ef­fect on weight. E

13.100 Start­ing at pu­ber­ty, pre­con­cep­tion coun­sel­ing should be in­cor­po­rat­ed into rou­tine di­a­betes clin­ic vis­its for all fe­males of child­bear­ing po­ten­tial be­cause of the ad­verse preg­nan­cy out­comes in this pop­u­la­tion. A

13.101 Pa­tients should be screened for smok­ing and al­co­hol use at di­ag­no­sis and reg­u­lar­ly there­after. C

Most youth with type 2 di­a­betes come from racial/‍eth­nic mi­nor­i­ty groups, have low so­cioe­co­nom­ic sta­tus, and often ex­pe­ri­ence mul­ti­ple psy­choso­cial stres­sors (22,35,123–126). Con­sid­eration of the sociocul­tur­al con­text and ef­forts to per­son­al­ize di­a­betes man­age­ment are of crit­i­cal im­por­tance to min­i­mize bar­ri­ers to care, en­hance ad­her­ence, and max­i­mize re­sponse to treat­ment.

Ev­i­dence about psy­chi­atric dis­or­ders and symp­toms in youth with type 2 di­a­betes is lim­it­ed (167-171), but given the sociocul­tur­al con­text for many youth and the med­i­cal bur­den and obe­si­ty as­so­ci­at­ed with type 2 di­a­betes, on­go­ing surveil­lance of men­tal health/be­hav­ioral health is in­di­cated. Symp­toms of de­pres­sion and dis­or­dered eat­ing are com­mon and as­so­ci­at­ed with poor­er glycemic con­trol (168,172,173).

Many of the drugs pre­scribed for di­a­betes and psy­chi­atric dis­or­ders are as­so­ci­at­ed with weight gain and can in­crease pa­tients’ con­cerns about eat­ing, body shape, and weight (174,175). The TODAY study doc­u­ment­ed (176) that de­spite dis­ease-‍ and age-‍specific coun­sel­ing, 10.2% of the fe­males in the co­hort be­came preg­nant over an av­er­age of 3.8 years of study par­tic­i­pa­tion. Of note, 26.4% of preg­nan­cies ended in a mis­car­riage, still­birth, or in­trauter­ine death, and 20.5% of the live-‍born in­fants had a major con­gen­i­tal anomaly.