Is diabetes distress on your radar screen?
Diabetes distress, which affects almost half of those with diabetes, contributes to worsening glycemic control. Recognizing and responding to it is essential.
PRACTICE RECOMMENDATIONS
› Educate patients about diabetes distress, explaining that diabetes is manageable and that neither complications nor diabetes distress is inevitable. C
› Empower patients to take an active role in self-management of diabetes, encouraging them to express their concerns and ask open-ended questions. A
› Support shared decision-making by inquiring about patients’ values and treatment preferences, presenting options, and reviewing the risks and benefits of each. C
Strength of recommendation (SOR)
A Good-quality patient-oriented evidence
B Inconsistent or limited-quality patient-oriented evidence
C Consensus, usual practice, opinion, disease-oriented evidence, case series
Unlike MDD, diabetes distress has a specific cause—diabetes—and can best be understood as an emotional response to a demanding health condition.13 And, because the source of the problem is identified, diabetes distress can be treated with specific interventions targeting the areas causing the highest levels of stress.
When a psychiatric condition and diabetes distress overlap
MDD, anxiety disorders, and diabetes distress are all common in patients with diabetes,24 and the co-occurrence of a psychiatric disorder and diabetes distress is high.25 Thus, it is important not only to identify cases of diabetes distress but also to consider comorbid depression and/or anxiety in patients with diabetes distress.
More often, though, it is the other way around, according to the Distress and Depression in Diabetes (3D) study. The researchers recently found that 84% of patients with moderate or high diabetes distress did not fulfill the criteria for MDD, but that 67% of diabetes patients with MDD also had moderate or high diabetes distress.13,15,17,25
The data highlight the importance of screening patients with a dual diagnosis of diabetes and MDD for diabetes distress. Keep in mind that individuals diagnosed with both diabetes distress and a comorbid psychiatric condition may require more complex and intensive treatment than those with either diabetes distress or MDD alone.25
Screening for diabetes distress
Diabetes distress can be easily assessed using one of several patient-reported outcome measures. Six validated measures, ranging in length from one to 28 questions, are designed for use in primary care (TABLE).26-30 Some of the measures are easily accessible online; others require subscription to MEDLINE.
