Published online May 15, 2015. doi: 10.4239/wjd.v6.i4.621
Peer-review started: December 2, 2014
First decision: January 20, 2015
Revised: January 28, 2015
Accepted: February 10, 2015
Article in press: February 12, 2015
Published online: May 15, 2015
It has long been accepted that psychological factors adversely influence efforts to optimise glycaemic control. These are often unrecognised in terms of clinical assessment and therefore under reported. This essay presents an introduction to psychological issues that interact with psychiatric co-morbidities and diabetes-specific distress, and a case scenario illustrating the interconnectedness of presenting problems and themes. In the way that we cannot separate carbohydrate counting, blood glucose monitoring and insulin dose adjustment in the understanding of a presenting problem such as poor control, so we cannot separate the concurrent thoughts, feelings, and behaviours. Each of these emotional aspects are self-managed either through avoidance, or by delayed disclosure and are frequently associated with poor health outcomes. There is a requirement for the healthcare team to be sensitised to these issues and to develop styles of communication that are empathic, reflective and non judgemental. A brief outline of evidence-based psychotherapy treatments is given.
Core tip: Psychological factors adversely influence efforts to optimise glycemic control. The focus on psychiatric diagnosis has done a disservice to people with diabetes who experience significant levels of sub-clinical distress and it is essential to develop an understanding of the psychological issues that underpin poor self-management of type 1 diabetes. The diabetes healthcare team needs to be sensitive to the underlying issues and to be confident in the use of consultation styles that facilitate recognition and appropriate signposting for specialised support and treatment.