Health and Wellbeing: Management of Type 2 Diabetes

Mental Health and Diabetes
Emotional well-being is an important part of diabetes care and self-management. Psychological distress can impair the individual’s ability to carry out diabetes care tasks and therefore increases risk of long term health complications. Meta-analytic studies have identified a 24-38% increased risk of depressive symptoms for Type 2 diabetes sufferers compared to the general population (Rotella & Manucci, 2013), and a 20% increased prevalence of anxiety disorders (Smith et al, 2013). Anxieties specific to diabetes including fear of hypoglycemia, invasive procedures and long term complications are highly prevalent and show a close association with glycemic control (Gonzalez et al 2015).

Benefits of Screening for Distress  Mental health

Given the potential health risks early identification of diabetes related stress is paramount. Furthermore enquiring about distress can enhance the clinician-patient relationship thus increasing the likelihood that the patient will engage with routine appointments

Screening                           

It is preferable to incorporate the following psychological assessment into routine care rather than waiting for a specific problem to arise;

  • Impact of diabetes on quality of life
  • Available social supports
  • Over-all stress levels
  • Diabetes specific stressors
  • Patient perception of ability to cope with stressors


The Problem Areas in Diabetes (PAID) and the Diabetes Distress Scale (DDS) are useful screening instruments to identify significant patient distress.

Depression and Anxiety

The association between depression and poor diabetes outcome is well documented, and routine screening is recommended (Ducat et al, 2014). The Hospital Anxiety and Depression Scale (HADS) is a self-report inventory that can also be used to identify clinical levels of anxiety. Routine screening for anxiety is less well researched and may be complicated by the fact symptoms of anxiety; involving affective and panic symptoms can be remarkably similar to symptoms of hypoglycemia.

Eating Disorders

Management of Type 2 diabetes involves components that raise the risk of disordered eating behaviours such as restriction of dietary choices and close monitoring of food choices. Warning signals include:

  • anxiety about weigh-ins
  • weight gain/loss
  • excessive exercise
  • frequent dieting; pre-occupation with meal-planning.

Recommendations

Patients identified as having mild/moderate difficulties may benefit from the following:

Self-help/ Online Resources

The “Healthy Ireland” website provides practical guidance for promoting positive mental health:
There are various mindfulness meditation websites and downloadable apps available
“Aware” provide a free online Cognitive Behavioural Therapy (CBT) Course for mild depression/anxiety:

Patients may also avail of self-help materials related to a variety of mental health difficulties:

Stress Control

‘Stress control’ is a free, six-session, information based course which may be of particular benefit to diabetes patients. You can find out more about the availability of these courses, and other available courses, by contacting your local Primary Care Psychology service.

Recruiting Support from Family Members

Diabetes self-management is most effective when it occurs in the context of close supportive relationships. The burden associated with care following a Type 2 diabetes diagnosis can cause additional strain to existing relationships. August et al (2013) found that spouses who tried to influence a patient’s diet and exercise experienced greater diabetes related distress and reported more negative marital interactions. The following guidance was therefore devised by the National Diabetes Education Initiative (NDEI) for families: Supporting a Family Member with Type 2 Diabetes

Indications for Referral to a Mental Health Service Include:

  • Complete disregard for diabetes self-care
  • Significant diabetes related distress
  • Difficulty coping with diagnosis
  • Depression
  • Anxiety
  • Indications of an eating disorder


The following services are available in Community Healthcare East (CHE):

Counselling in Primary Care Service (CIPC)
6-8 sessions for patients with medical cards

CiPC Referral Form


Adult Mental Health Services: Moderate to severe difficulties

Primary Care Psychology: Mild to moderate difficulties

General Mental Health Referral Guidelines


References

August, K.J., Rook, K.S., Franks, M.M., & Parris Stephens, M.A. (2013). Spouses’ involvement in their partners’ diabetes management: Association with spouse stress and perceived marital quality. Journal of Family Psychology, 27, 712 -721.

Ducat, L.H., Philipson, L.H. & Anderson, B.J. (2014). Routine depression screening for patients with diabetes. JAMA, 312 – 2413.

Gonzalez, J.S., Shreck, E., Psaros, C., &Safren, S.A. (2015). Distress and type 2 diabetes-treatment adherence: A mediating role for perceived control. Health Psychology, 34, 505-513.

Rotella, F., & Manucci, E. (2013). Depression as a risk for diabetes: A meta-analysis of longitudinal studies. The Journal of Clinical Psychiatry

Smith, K. J., Beland, M., Clyde, M., Gariepy, G., Page, V., Badawi., G., Schmitz, N. (2013). Association of diabetes with anxiety: A systematic review and met-analysis. Journal of Psychosomatic research, 74, 89-99.