Diabetes Emotional Distress – Are Clinicians Missing Part of their Patients’ Story?

Practice Points - Diabetes Emotional Distress

Today, healthcare organizations and clinicians are increasingly asked by payors and employers to improve care quality, reduce gaps in care, and foster patient engagement in treatment. This is part of a growing national emphasis on value-based and whole-person care, particularly for the costly chronic conditions that impact more than 133 million people in the US. Type 2 diabetes is a particularly demanding chronic condition for patients in terms of its treatment burden, the impact of complications, social stigma, and financial strain. In this article, we focus on practical ways for clinical teams to address the emotional aspects of living with type 2 diabetes as part of routine clinical activities and patient care.

Studies show that approximately 20-45% of patients living with diabetes are emotionally overwhelmed and at risk of disengaging from treatment or becoming depressed. “Diabetes distress” as it is known clinically, is now recognized as a key “vital sign” by both the Centers for Disease Control and the American Diabetes Association. These organizations stress the importance of front-line clinicians addressing patients’ emotional and social needs and helping them accomplish the day-to-day tasks of disease self-management.

Why is living with type 2 diabetes emotionally demanding?

As with other chronic conditions, such as cardiovascular disease, hypertension, and chronic kidney disease, living with type 2 diabetes means that patients often need to change many of their daily, routine lifestyle habits. These include changing eating and drinking habits; adhering to some food restrictions; achieving weight loss; increasing daily physical activity; monitoring blood glucose, blood pressure, and blood lipid levels; taking prescribed diabetes medications; and planning for clinical procedures and hospital visits. These many tasks can understandably become stressful for patients over time because of the extra effort and time required to accomplish and sustain them. Fitting these tasks into normal family and work life can also be a challenge. There is a great deal of new learning and skills for the patient to master if they are to effectively manage diabetes. And there are psychological and social adjustments that must be made to acclimate to the social stigma around diabetes, to cope with other people’s unwanted suggestions about food and lifestyle choices, and to deal with the challenges of insurance planning and/or finding ways to pay for medical expenses.

The emotional burden of type 2 diabetes can also include the impact of emerging or worsening diabetes complications. These complications can include cardiovascular disease, leading to heart attacks and stroke; heart failure; chronic kidney disease, leading to dialysis; diabetic retinopathy and loss of vision; amputations (toes, feet, and lower limbs); nerve pain; and sexual functioning problems. Luckily, many of these complications are often avoidable with the right help from the clinical team.

Patients living with type 2 diabetes can also face an understandable sense of frustration and helplessness when they experience day-to-day fluctuations in their blood glucose levels, despite their best efforts to follow the treatment plan. Fluctuations can occur even when a patient has carried out the same routine of eating, taking medications, and physical activity as they did on a day when their blood glucose levels did not fluctuate. Patients need to continually balance powerful, prescribed medications such as insulin, with different meals and physical activity levels, and in some cases, worry about the risk of low blood sugars (hypoglycemia), which can become life threatening in severe cases where insulin therapy is prescribed.

Patients may also face normal emotional, occupational, and social upheavals in their life that typically require additional medical support and social services, and this adds to experienced diabetes distress.

Despite this powerful array of potential emotional impacts on patients living with type 2 diabetes, emotional distress is not regularly assessed or managed in the U.S. healthcare system today and statistics show that less than 5% of diabetes patients are referred by their primary care team to a diabetes care and education specialist.

In our upcoming series of articles on diabetes distress, we will share more about this underrecognized symptom of diabetes and how clinical care providers can support patients who are experiencing distress managing diabetes using new digital tools such as the Silver Fern Behavior Diagnostic Platform and its suggested clinical strategies.

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Garry Welch, PhD, Co-Founder and Chief Scientific Officer, is a foremost expert in the area of behavior medicine for chronic disease care. He has extensive experience leading clinical research on behavior change strategies for people with diabetes and other chronic diseases. Dr. Welch’s 30+ years of clinical research led to co-founding Silver Fern Healthcare. He leads research and development at Silver Fern.