Dr. Kumar Prafull Chandra
Diabetes is not just a disease of physical health; its diagnosis also hampers mental health. People living with diabetes are twice as likely to suffer from depression. Further, certain psychological conditions are specific to diabetes, such as – diabetes distress, fear of injections or hypos, and eating disorders. Individuals with poor emotional and psychological wellbeing have a poorer quality of life––poor glycemic control––and increased healthcare costs.
A large part of the distress is the need for self-management in diabetes. Diabetes is not merely a physical health condition; it has behavioral, psychological, emotional, and social impacts.
National and International suggest that authorities and HCPs should join hands in offering emotional and psychological support for people with diabetes. Screening for depression should be performed routinely for adults with diabetes; patients with depression should be referred to mental healthcare professionals.
Clinical guidelines for T1DM management state that these patients are prone to clinical and subclinical depression/anxiety. Regular assessment of psychological and behavioral aspects is warranted in T1DM patients, including evaluations of anxiety/depression and eating disorders.
Clinical guidelines for T2DM management indicate annual mental health screening for these patients. Further, exploring the social situation, attitudes, beliefs, and worries associated with diabetes and self-care issues and periodically assessing the wellbeing is warranted.
Communication and patient engagement should be open-ended; supportive HCPs should engage in patient counseling. Communication skills should be empathic, which is important for improving the quality of consultations. Active listening is the best way to improve communication, and verbal and non-verbal communication strategies can be learned by HCPs. Gestures and observances are vital in communicating non-verbally. Patients’ expressions must be heeded, and cultural variations must be considered. Additionally, comprehension should be ensured by clarifications. When in doubt, patients should be asked to repeat instructions.
A dialectician should build a rapport with the patient to enhance motivation. Explaining in simple language and short sentences is warranted. Also, accept feedback to aid in improvising. Provide the patient adequate time to reiterate all issues and elaborate – a non-hurried consultation makes patients feel at ease; address all significant complaints. At the end of the consultation, summarize the main issues and action plans agreed upon. Offer an early follow-up appointment – to make the patient feel that they are not alone and to evade psychological distress.
Living with diabetes entails multiple reactions and modifications. In addition, emotional response to diabetes-related diagnosis can be variable. The emotional and psychological journey after diabetes diagnosis can be different for all patients, but most require HCP support to process their emotional turmoil. The initial reactions can range from apathy and denial to self-blame.
Diabetes distress is the emotional response to living with diabetes, including dietary restrictions, exercise, diagnostic measures, monitoring, therapies, and costs. Diabetes distress is relatively common and impacts self-care. It should be evaluated and identified among diabetes patients.
The 7As model can help identify diabetes distress – Aware, ask, assess, advise, assist, assign – refer, and arrange – follow-up. Fear of hypoglycemia should be addressed. Be mindful of fear – a typical response; encourage adaptive fear. Psychological barriers to Insulin use should be addressed.
Mental healthcare professional referral may be warranted in cases with eating disorders and severe depression. Some mental health disorders may warrant immediate attention.
Dr. Kumar Prafull Chandra is Director, Dept. of Internal Medicine & Diabetes care, Healthcity Vistaar Hospital; and, Chandra Diabetes & Obesity Clinic, Gomtinagar, Lucknow