Studies show that approximately 20–45% of patients living with diabetes are emotionally overwhelmed and at risk of disengaging from treatment or becoming depressed. Few doctors are aware of these patient struggles, but “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 rates show that diabetes distress is common and worthy of clinical attention. Unfortunately, only 24% of patients report being asked about their level of diabetes distress and the reasons for this distress by their clinicians.
Providing treatment support for alleviating diabetes distress is an area where allied health professionals with training in diabetes care, such as diabetes educators and health coaches, play an important role. That is because diabetes distress is directly related to the daily burdens of managing the disease. Treatment not only can alleviate anxiety but can also lead to improved daily self-management.
Once you have determined that the patient is suffering from diabetes distress, either through a conversation with the patient or a formal assessment, then consider implementing some of the strategies listed below. These strategies might help the patient manage and potentially reduce their diabetes distress depending on their individual situation.
- Provide the patient with the time and opportunity to discuss the emotional burden of diabetes. Open, exploratory conversations, even brief, have been found to provide a sense of relief and validation to patients that is therapeutic and reduces the level of distress felt. For some patients, a simple airing of the distress and related self-management problems can significantly benefit the patient and help put things back into perspective.
- Ask the patient about the most difficult aspect of caring for their diabetes or the thing that is most problematic for them at this moment. There are many tasks associated with managing diabetes, so it is helpful to identify the areas that the patient finds personally challenging. Then it is possible to work with them to modify the treatment plan to make it more workable and less stressful in targeted areas.
- Reassure the patient that it is normal to becoming frustrated, overwhelmed, and/or scared at times when living with a chronic disease. Diabetes is a complex and demanding chronic condition. It is important to acknowledge the burden of the disease and the seriousness of the associated complications. You can support the patient by helping them learn strategies to engage in positive self-care behaviors so that living with the disease is more manageable.
- Suggest that the patient discuss their feelings with their health care team or refer them to a specialist. After asking questions and learning more about the specific sources of the patient’s distress, you may find that they will benefit from a particular type of treatment support that is outside of your particular area of expertise. In these cases, it is appropriate to refer the patient to another provider, such as a support group, a certified diabetes educator, or a member of the behavioral healthcare team.
- Suggest that the patient reach out to family and friends to discuss the sources of their distress and to ask for assistance. For some patients, family and friends can become a source of support. Help the patient identify places where they think support from family and friends could help reduce their distress and then offer to practice or roleplay how the patient can start the conversation.
A patient’s level of diabetes distress may fluctuate over time and can increase with the presence of significant life stressors (e.g., job changes or job loss, divorce, financial or legal problems). It is important to assess diabetes distress regularly as part of planned medical or wellness exams and to modify or adjust the treatment plan as appropriate to address the patient’s current situation and needs. Please visit our website for more articles and clinical insights about diabetes distress written by Dr. Garry Welch and Nora Saul.