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and improvement in fitness levels in indi-\nviduals with type 2 diabetes. Because HIIT\nc a nl e a dt ot r a n s i e n ti n c r e a s e si np o s t -exercise hyperglycemia, individuals with\ntype 2 diabetes are encouraged to moni- | [
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type 2 diabetes are encouraged to moni-\ntor blood glucose when starting (320). Intype 1 diabetes, HIIT is associated withreductions in A1C levels, reduction in in-\nsulin requirements, and improvement incardiometabolic risk profi les (322). Vari- | [
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ability in glucose may occur with an in-creased risk in delayed hypoglycemia, socareful monitoring of glucose during andafter HIIT is advised (322).\nPre-exercise Evaluation\nAs discussed more fully in Section 10,“Cardiovascular Disease and Risk\nManagement, ”the best protocol for | [
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Management, ”the best protocol for\nassessing asymptomatic people withdiabetes for coronary artery diseaseremains unclear. The ADA consensus re-port “Screening for Coronary Artery Dis-\nease in Patients With Diabetes ”(324)\nconcluded that routine testing is not rec-ommended. However, health care profes-sionals should ... | [
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assess cardiovascular risk factors, and be | [
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aware of the atypical presentation of cor-onary artery disease, such as recent re-ported or tested decrease in exercisetolerance in people with diabetes. Cer-tainly, those with high risk should be en-couraged to start with short periods oflow-intensity exercise and slowly increasethe duration and intensity as tolerated... | [
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Health care professionals should assess\nfor conditions that might contraindicatecertain types of exercise or predispose toinjury, such as uncontrolled hypertension,untreated proliferative retinopathy, au-tonomic neuropathy, peripheral neuropa-thy, balance impairment, and a history offoot ulcers or Charcot foot. Age an... | [
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ous physical activity level should be con-\nsidered when customizing the exerciseplan to the individual’ sn e e d s .T h o s ew i t h\ncomplications may need a more thoroughevaluation prior to starting an exerciseprogram (293).\nHypoglycemia\nIn individuals taking insulin and/or insu-lin secretagogues, physical activit... | [
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cause hypoglycemia if the medication\ndose or carbohydrate consumption isnot adjusted for the exercise bout andpost-bout impact on glucose. Individualson these therapies may need to ingestsome added carbohydrate if pre-exercise glu-cose levels are <90 mg/dL (< 5.0 mmol/L),\ndepending on whether they are able tolower in... | [
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( s u c ha sw i t ha ni n s u l i np u m po rr e d u c e d\npre-exercise insulin dosage), the time ofday exercise is done, and the intensityS88 Facilitating Positive Health Behaviors and Well-being Diabetes Care Volume 47, Supplement 1, January 2024\n©AmericanDiabetesAssociation | [
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and duration of the activity (293). In\nsome people with diabetes, hypoglycemia\nafter exercise may occur and last for sev-\neral hours due to increased insulinsensitivity. Hypoglycemia is less commonin those who are not treated with insulin\nor insulin secretagogues, and no routine | [
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or insulin secretagogues, and no routine\npreventive measures for hypoglycemiaare usually advised in these cases. Intenseactivities may actually raise blood glucose\nlevels instead of lowering them, especially | [
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levels instead of lowering them, especially\nif pre-exercise glucose levels are elevatedFigure 5.1 —Importance of 24-h physical behaviors for type 2 diabetes. Reprinted from Davies et al. (97).diabetesjournals.org/care Facilitating Positive Health Behaviors and Well-being S89\n©AmericanDiabetesAssociation | [
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(293). Because of the variation in glycemic\nresponse to exercise bouts, people with dia-betes need to be educated to check blood\nglucose levels or consult sensor glucose val-\nues before and after periods of exercise and\nabout the potential prolonged effects (de-\npending on intensity and duration) (325).\nExercise ... | [
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pending on intensity and duration) (325).\nExercise in the Presence of\nMicrovascular Complications\nSee Section 11, “Chronic Kidney Disease\nand Risk Management, ”and Section 12,\n“Retinopathy, Neuropathy, and Foot Care, ”\nfor more information on these long-term\ncomplications. A meta-analysis on this topic\ndemonstr... | [
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demonstrated moderate certainty of evi-\ndence that high versus low levels of physical\nactivity were associated with lower CVD in-cidence and mortality (summary risk ratio\n0.84 [95% CI 0.77 –0.92], n=7 ,a n d0 . 6 2\n[0.55 –0.69], n= 11) and fewer microvascu-\nlar complications (0.76 [0.67 –0.86], n=8 ) . | [
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lar complications (0.76 [0.67 –0.86], n=8 ) .\nDose-response meta-analyses showed thatphysical activity was associated with lower\nrisk of diabetes-related complications evenat lower levels (326).\nRetinopathy\nIf proliferative diabetic retinopathy or se-vere nonproliferative diabetic retinopathyis present, then vigoro... | [
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or resistance exercise may be contraindi-\ncated because of the risk of triggering vit-\nreous hemorrhage or retinal detachment\n(327). Consultation with an ophthalmolo-\ngist prior to engaging in an intense exer-\ncise plan may be appropriate.\nPeripheral Neuropathy\nDecreased pain sensation and a higher\npain thresho... | [
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pain threshold in the extremities can re-\nsult in an increased risk of skin breakdown,\ninfection, and Charcot joint destruction\nwith some forms of exercise. Therefore, athorough assessment should be done to\nensure that neuropathy does not alter kin-\nesthetic or proprioceptive sensation dur-\ning physical activity,... | [
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ing physical activity, particularly in those\nwith more severe neuropathy. Studies\nhave shown that moderate-intensity walk-\ning may not lead to an increased risk offoot ulcers or reulceration in those with\nperipheral neuropathy who use proper\nfootwear (328). In addition, 150 min/\nweek of moderate exercise was repo... | [
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week of moderate exercise was reported\nt oi m p r o v eo u t c o m e si np e o p l ew i t hp r e -\ndiabetic neuropathy (329). All individuals\nwith peripheral neuropathy should wearproper footwear and examine their feet\ndaily to detect lesions early. Anyone witha foot injury or open sore should be re-\nstricted to n... | [
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stricted to non –weight-bearing activities.\nAutonomic Neuropathy\nAutonomic neuropathy can increase therisk of exercise-induced injury or adverse\nevents through decreased cardiac respon-\nsiveness to exercise, postural hypotension,impaired thermoregulation, impaired night\nvision due to impaired papillary reaction, | [
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vision due to impaired papillary reaction,\nand greater susceptibility to hypoglycemia(330). Cardiovascular autonomic neuropa-\nthy is also an independent risk factor for\ncardiovascular death and silent myocardialischemia (331). Therefore, individuals with\ndiabetic autonomic neuropathy should un- | [
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diabetic autonomic neuropathy should un-\ndergo cardiac investigation before begin-ning physical activity more intense thanthat to which they are accustomed.\nDiabetic Kidney Disease\nPhysical activity can acutely increase uri-nary albumin excretion. However, thereis no evidence that vigorous-intensity ex-\nercise acce... | [
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ercise accelerates the rate of progression\nof DKD, and there appears to be no needfor speci fic exercise restrictions for peo-\nple with DKD in general (327).\nSMOKING CESSATION: TOBACCO,\nE-CIGARETTES, AND CANNABIS\nRecommendations\n5.32 Advise all people with diabetes\nnot to use cigarettes and other to-\nbacco produ... | [
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not to use cigarettes and other to-\nbacco products or e-cigarettes. A\n5.33 As a routine component of dia-\nbetes care and education, ask peoplewith diabetes about the use of ciga-\nrettes or other tobacco products. Af-ter identi fication of use, recommend | [
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and refer for combination treatmentconsisting of both tobacco/smokingcessation counseling and pharmaco-\nlogical therapy. A\nA causal link between cigarette smoking\nand diabetes has been established and re-\nported on by the Surgeon General forover a decade (332). Results from epide-miologic, case-control, and cohort ... | [
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provide convincing evidence to support\nthe causal link between cigarette smokinga n dm u l t i p l eh e a l t hr i s k st h a tc a nh a v ea\nprofound impact on morbidity and mortal-\nity for people with diabetes (332). Peoplewith diabetes who smoke and are exposed\nto second-hand smoke have a heightened | [
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to second-hand smoke have a heightened\nrisk of macrovascular complications (e.g.,cardiovascular and peripheral vascular dis-\nease), microvascular complications (e.g.,kidney disease and visual impairment),worse glycemic outcomes, and prematured e a t hc o m p a r e dw i t ht h o s ew h od on o t\nsmoke (333 –336). Eme... | [
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smoke (333 –336). Emerging data suggest\nsmoking has a role in the development of\ntype 2 diabetes, and quitting has beenshown to signi ficantly decrease this risk\nover time (337 –340).\nThe routine (every visit with every per-\nson), thorough assessment of all types oftobacco use is essential to prevent to-bacco produ... | [
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sation. Evidence demonstrates signi ficant\nbenefits to quitting smoking for all people,\nresulting in a reduction and even reversal\nof adverse health effects in addition to\nan increase in life expectancy by as much\nas a decade (341). However, data show to-bacco use prevalence among adults withchronic conditions has r... | [
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tently higher than that in the general popu-\nlation (342), with recent declines in smokingin middle-aged people with diabetes butnot in adolescents and young adults (342).\nNumerous large RCTs have demonstrated\nthe ef ficacy and cost-effectiveness of both | [
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the ef ficacy and cost-effectiveness of both\nintensive and brief counseling in smokingcessation, including the use of telephonequit lines and web-based interventions, in\nreducing tobacco use and maintaining absti-\nnence from smoking (341,343,344). Currentrecommendations include both counselingand pharmacologic therap... | [
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smoking cessation in nonpregnant adults\n(345); however, more than two-thirds ofpeople trying to quit do not receive treat-ment following evidence-based guidelines\n(341).\nWeight gain after smoking cessation has\nbeen a concern related to diabetes man-\nagement and risk for new onset of disease(346). While post-cessat... | [
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an identi fied issue, studies have found that\nan average weight gain of 3 –5 kg does not\nnecessarily persist long term or diminish\nthe substantial cardiovascular bene fit real-\nized from smoking cessation (337). Thesefindings highlight the need for tobacco | [
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cessation treatment that addresses eatingand physical activity needs. One study inpeople with newly diagnosed type 2 diabe-\ntes who smoke found that smoking cessa-\ntion was associated with amelioration ofmicroalbuminuria and reduction in bloodpressure after 1 year (347).\nIn recent years, there has been an in- | [
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In recent years, there has been an in-\ncrease in the use and availability of mul-tiple noncigarette nicotine products. TheS90 Facilitating Positive Health Behaviors and Well-being Diabetes Care Volume 47, Supplement 1, January 2024\n©AmericanDiabetesAssociation | [
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evidence regarding the effect of these\nproducts on diabetes is not as clearas that for combustible cigarettes. It isknown that smokeless tobacco products,such as dip and chew, pose an increased\nrisk for CVD (348). E-cigarettes and vap- | [
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risk for CVD (348). E-cigarettes and vap-\ning have gained public awareness andpopularity because of perceptions thate-cigarette use is less harmful than regular\ncigarette smoking (349,350). While com-\nbustible tobacco products are clearly themost harmful, electronic products shouldnot be characterized as harmless, a... | [
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risks with use that affect the cardiovascu-\nlar and respiratory systems have beenidenti fied (351,352). Individuals with di-\nabetes should be advised to avoid vap-ing and using e-cigarettes, either as a\nway to stop smoking combustible ciga- | [
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way to stop smoking combustible ciga-\nrettes or as a recreational drug. If peo-ple are using e-cigarettes to quit, theyshould be advised to avoid using both\ncombustible and electronic cigarettes,\nand if using only e-cigarettes, they shouldbe advised to have a plan to quit thesealso (344).\nIncreased legalization and... | [
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Increased legalization and multiple for-\nm u l a t i o n so fc a n n a b i sp r o d u c t sh a v er e -sulted in increased prevalence in the useof these products in all age-groups (353,354). Signi ficant increases in tetrahydro- | [
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cannabinol (THC) concentrations and useof additional psychoactive cannabinoidproducts, such as delta-8 THC, are of spe-cific concern (355). Most of these prod-\nucts are currently unregulated by the\nFDA, and public health warnings regard- | [
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FDA, and public health warnings regard-\ning use have been issued (356). The FDAreports adverse effects related to delta-8T H C ,s o m eo fw h i c hm a yh a v eh e a l t h\nimplications for people with diabetes\n(e.g., vomiting) (356). Evidence of spe-cific increased risk of diabetic ketoacido-\nsis and hyperglycemic ke... | [
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sis and hyperglycemic ketosis associated\nwith cannabis use and cannabis hyper-\nemesis syndrome in adults with type 1diabetes has been recently reported(357 –359).\nDiabetes education programs offer po- | [
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Diabetes education programs offer po-\ntential to systematically reach and engageindividuals with diabetes in smoking ces-sation efforts. A cluster randomized trialfound statistically signi ficant increases in\nquit rates and long-term abstinence rates\n(>6 months) when smoking cessation\ninterventions were offered thro... | [
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interventions were offered through dia-\nbetes education clinics, regardless of mo-tivation to quit at baseline (360). The\nincreased prevalence in use of an ex-\npanding landscape of both tobacco andcannabis products and the impact on the | [
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health of people with diabetes highlightst h en e e dt oa s ka b o u tu s eo ft h e s ep r o d -ucts, educate individuals regarding theassociated risks, and provide support forcessation.\nSUPPORTING POSITIVE HEALTH\nBEHAVIORS\nRecommendation\n5.34 Behavioral strategies should\nbe used to support diabetes self- | [
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5.34 Behavioral strategies should\nbe used to support diabetes self-\nmanagement and engagement in healthbehaviors (e.g., taking medications, us-ing diabetes technologies, and engagingin physical activity and healthy eating)to promote optimal diabetes health out-comes. A\nGiven associations with glycemic outcomes | [
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Given associations with glycemic outcomes\nand risk for future complications (361,362), | [
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it is important for diabetes care professio-nals to support people with diabetesto engage in health-promoting behaviors(preventive, treatment, and maintenance),including blood glucose monitoring, takinginsulin and medications, using diabetestechnologies, engaging in physical activity,and making nutritional changes. Evi... | [
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making nutritional changes. Evidences u p p o r t su s i n gav a r i e t yo fb e h a v i o r a ls t r a t -egies and multicomponent interventions tohelp people with diabetes and their care-givers or family members develop healthbehavior routines and overcome barriersto self-management behaviors (363 –365). | [
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Behavioral strategies with empirical sup-port include motivational interviewing(366– 368), patient activation (369), goal\nsetting and action planning (368,370 –372),\nproblem-solving (371,373), tracking or self-monitoring health behaviors with orwithout feedback from a health care pro-fessional (368,370 –372), and fac... | [
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opportunities for social support (368,371,372). There is mixed evidence aboutbehavioral economics strategies (e.g., fi-\nnancial incentives and exposure to infor-mation about social norms) to promoteengagement in health behaviors amongpeople with diabetes; such strategiestend to enhance intentions and demon-strate short... | [
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change, although there is less evidenceabout sustained effects (374). Multicom-ponent behavior change interventionpackages have the highest ef ficacy for\nbehavioral and glycemic outcomes(363,372,375). For youth with diabetes,family-based behavioral intervention | [
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packages and multisystem interventionsthat facilitate health behavior changedemonstrate bene fit for increasing man-\nagement behaviors and improving glyce-mic outcomes (364). As with all diabeteshealth care, it is important to adapt andtailor behavior change strategies to the\ncharacteristics and needs of the individua... | [
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characteristics and needs of the individual\nand population (376 –378). Health behavior\nchange strategies may be delivered by be-havioral health professionals, DCES, other\ntrained health care professionals (370,\n379– 381), or quali fied community health\nworkers (370,371). These approaches may\nbe delivered via digit... | [
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be delivered via digital health tools (372,\n380,382). There are effective strategies totrain diabetes care professionals to usesuch methods (e.g., motivational inter-\nviewing) (383).\nPSYCHOSOCIAL CARE\nRecommendations\n5.35 Psychosocial care should be pro-\nvided to all people with diabetes, with | [
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vided to all people with diabetes, with\nthe goal of optimizing health-relatedquality of life and health outcomes.Such care should be integrated withroutine medical care and delivered bytrained health care professionals using\na collaborative, person-centered, cul-\nturally informed approach. A\n5.36 Diabetes care team... | [
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turally informed approach. A\n5.36 Diabetes care teams should im-\nplement psychosocial screening proto-cols for general and diabetes-relatedmood concerns as well as other topicssuch as stress, quality of life, availableresources ( financial, social, family, and | [
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emotional), and/or psychiatric history.Screening should occur at least annuallyor when there is a change in disease,treatment, or life circumstances. C\n5.37 When indicated, refer to behav-\nioral health professionals or othertrained health care professionals, ide-ally those with experience in diabetes,\nfor further as... | [
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for further assessment and treatment\nf o rs y m p t o m so fd i a b e t e sd i s t r e s s ,depression, suicidality, anxiety, treat-ment-related fear of hypoglycemia,disordered eating, and/or cognitive ca-pacities. Such specialized psychosocial\ncare should use age-appropriate stan-\ndardized and validated tools and t... | [
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dardized and validated tools and treat-ment approaches. B\n5.38 Consider developmental factors\nand use age-appropriate validated toolsfor psychosocial screening in peoplewith diabetes. Ediabetesjournals.org/care Facilitating Positive Health Behaviors and Well-being S91\n©AmericanDiabetesAssociation | [
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0.032880... |
Please refer to the ADA position state-\nment “Psychosocial Care for People With\nDiabetes ”for a list of assessment tools\nand additional details (1) and the ADA Be-\nhavioral Health Toolkit for assessmentquestionnaires and surveys (professional\n.diabetes.org/meetings/behavioral-health- | [
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.diabetes.org/meetings/behavioral-health-\ntoolkit). Throughout the Standards of Care,the broad term “behavioral health ”is\nused to encompass both 1) health behav-\nior engagement and relevant factors and2) behavioral health concerns and care re-\nlated to living with diabetes.\nComplex environmental, social, family, | [
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lated to living with diabetes.\nComplex environmental, social, family,\nbehavioral, and emotional factors, knownas psychosocial factors, infl uence living\nwith type 1 and type 2 diabetes and\nachieving optimal health outcomes and\npsychological well-being. Thus, individualswith diabetes and their families are chal- | [
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lenged with complex, multifaceted issues\nwhen integrating diabetes care into dailylife (384). Clinically signi ficant behavioral\nhealth diagnoses are considerably moreprevalent in people with diabetes than inthose without (385 –387). Emotional well-\nbeing is an important part of diabetes\ncare and self-management. Ps... | [
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care and self-management. Psychological\nand social problems can impair the indi-vidual ’s( 5 7 , 3 8 8 –392) or family ’s( 3 9 1 )\nability to carry out diabetes care tasksand potentially compromise health sta-tus. Therefore, psychological symptoms,\nboth clinical and subclinical, must be ad- | [
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both clinical and subclinical, must be ad-\ndressed. In addition to impacting a per-son’s ability to carry out self-management\nand the association of behavioral healthdiagnoses with poorer short-term glyce-mic stab ility, symptoms of emotional\ndistress are associated with increasedmortality risk (386,393).\nThere are... | [
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There are opportunities for diabetes\nhealth care professionals to routinely mon-itor and screen psychosocial status in a\ntimely and ef ficient manner for referral to\nappropriate services (394,395). Various\nhealth care professionals working with\npeople with diabetes may contribute to | [
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people with diabetes may contribute to\npsychosocial care in different ways basedon training, experience, need, and avail-\nability (380,396,397). Ideally, quali fied\nbehavioral health professionals with spe-\ncialized training and experience in diabetes\nshould be integrated with or provide collab- | [
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should be integrated with or provide collab-\norative care as part of diabetes care teams(398– 401). Referrals for in-depth assess-\nment and treatment for psychosocial con-c e r n ss h o u l db em a d et os u c hb e h a v i o r a lhealth professionals when indicated (381,402,403). A systematic review and meta- | [
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analysis showed that psychosocial interven-\ntions modestly but signi ficantly improved\nA1C and behavioral health outcomes (404).There was a limited association between\nthe effects on A1C and behavioral health,\nand no intervention characteristics pre-dicted bene fito nb o t ho u t c o m e s .H o w e v e r ,\ncost anal... | [
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cost analyses have shown that behavioral\nhealth interventions are both effective and\ncost-ef ficient approaches to the prevention\nof diabetes (405).\nScreening\nHealth care teams should develop and im-plement psychosocial screening protocols\nto ensure routine monitoring of psychoso- | [
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to ensure routine monitoring of psychoso-\ncial well-being and to identify potentialconcerns among people with diabetes,following published guidance and recom-\nmendations (406 –411). Topics to screen\nfor may include, but are not limited to, at-\ntitudes about diabetes, expectations fortreatment and outcomes (especial... | [
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lated to starting a new treatment or tech-\nnology), general and diabetes-relatedmood, stress, and/or quality of life (e.g.,diabetes distress, depressive symptoms,\nanxiety symptoms, and/or fear of hypo-\nglycemia), available resources ( financial,\nsocial, family, and emotional), and/or psy-chiatric history. Given elev... | [
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suicidality among people with diabetes\n(412– 415), screening for suicidality may\nalso be appropriate (416 –418), similar to\nU.S. Preventive Services Task Force state-\nments regarding screening for some adoles-\ncents and adults in the general population(419,420). A list of age-appropriate screen-ing and evaluation ... | [
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the ADA position statement “Psychosocial\nCare for People with Diabetes ”(1), and\nguidance has been published about selec-\ntion of screening tools, clinical thresholds,\nand frequency of screening (408,421). Key\nopportunities for psychosocial screeningoccur at diabetes diagnosis, during regularlyscheduled management... | [
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hospitalizations, with new onset of com-\nplications, during signifi cant transitions in\ncare such as from pediatric to adult careteams (422), at the time of medical treat-\nment changes, or when problems with\nachieving A1C goals, quality of life, or self-management are identi fied. People with\ndiabetes are likely to ... | [
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diabetes are likely to exhibit psychological\nvulnerability at diagnosis, when their\nmedical status changes (e.g., end of thehoneymoon period), when the need forintensi fied treatment is evident, and when\ncomplications are discovered. Signi ficant\nchanges in life circumstances and SDOH\nare known to considerably affec... | [
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are known to considerably affect a per-\nson’s ability to self-manage their condition.\nThus, screening for SDOH (e.g., loss ofemployment, birth of a child, or otherfamily-based stresses) should also be incor-\nporated into routine care (423). In cir-cum-\nstances where individuals other than theperson with diabetes ar... | [
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volved in diabetes management (e.g., care-givers or family members), these issues\nshould be monitored and treated by ap-\npropriate professionals (422,424,425).\nStandardized, validated, age-appropri-\nate tools for psychosocial monitoringand screening can also be used (1). TheADA provides access to tools for screen- | [
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ing speci fic psychosocial topics, such as\ndiabetes distress, fear of hypoglycemia,and other relevant psychological symp-\ntoms at professional.diabetes.org/sites/default/ files/media/ada_mental_health_\ntoolkit_questionnaires.pdf. Additional in-formation about developmentally spe-\ncific psychosocial screening topics is | [
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cific psychosocial screening topics is\navailable in Section 14, “Children and\nAdolescents,” and Section 13, “Older\nAdults. ”Health care professionals may\nalso use informal verbal inquires, for\nexample, by asking whether there have\nbeen persistent changes in mood during\nthe past 2 weeks or since the individual ’s | [
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the past 2 weeks or since the individual ’s\nlast appointment and whether the personcan identify a triggering event or change incircumstances. Diabetes care professionals\nshould also ask whether there are new or\ndifferent barriers to treatment and self-management, such as feeling overwhelmed\nor stressed by having di... | [
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or stressed by having diabetes (see\nDIABETES\nDISTRESS ,b e l o w ) ,c h a n g e si n finances, or com-\npeting medical demands (e.g., the diagnosisof a comorbid condition).\nPsychological Assessment and\nTreatment\nWhen psychosocial concerns are identi-\nfied, referral to a quali fied behavioral | [
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fied, referral to a quali fied behavioral\nhealth professional, ideally one specializingin diabetes, should be made for compre-\nhensive evaluation, diagnosis, and treat-\nment (380,381,402,403). Indications forreferral may include positive screening for\noverall stress related to work-life balance,\ndiabetes distress, d... | [
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diabetes distress, diabetes management\ndifficulties, depression, anxiety, disordered\neating, and cognitive dysfunction (see\nTable 5.2 for a complete list). It is prefera-\nble to incorporate psychosocial assessmentS92 Facilitating Positive Health Behaviors and Well-being Diabetes Care Volume 47, Supplement 1, January... | [
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©AmericanDiabetesAssociation | [
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and treatment into routine care rather\nthan waiting for a speci fic problem or de-\nterioration in metabolic or psychologicalstatus to occur (39,391). Health care pro-fessionals should identify behavioral healthprofessionals, knowledgeable about diabe-\ntes treatment and the psychosocial as- | [
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tes treatment and the psychosocial as-\npects of diabetes, to whom they can referindividuals. The ADA provides a list of be-havioral health professionals who havespecialized expertise or who have received\neducation about psychosocial and behav- | [
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education about psychosocial and behav-\nioral issues related to diabetes in the ADAMental Health Professional Directory(professional.diabetes.org/ada-mental-health-provider-directory). Ideally, be-\nhavioral health professionals should be | [
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havioral health professionals should be\nembedded in diabetes care settings. Inrecognition of limited behavioral healthresources and to optimize availability,other health care professionals who\nhave been trained in behavioral health in- | [
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have been trained in behavioral health in-\nterventions may also provide this special-ized psychosocial care (396,399,426,427).Although some health care professionalsmay not feel quali fied to treat psychologi-\ncal problems (428), strengthening the\nrelationship between a person with dia- | [
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relationship between a person with dia-\nbetes and the health care professionalmay increase the likelihood of the individ-ual accepting referral for other services.Collaborative care interventions and a\nteam approach have demonstrated ef fi-\ncacy in diabetes self-management, out- | [
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cacy in diabetes self-management, out-\ncomes of depression, and psychosocialfunctioning (5,6). The ADA provides re-sources for a range of health professio-\nnals to support behavioral health in\npeople with diabetes at professional.diabetes.org/meetings/behavioral-health-toolkit.\nEvidence supports interventions for | [
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Evidence supports interventions for\npeople with diabetes and psychosocial\nconcerns, including issues that affectbehavioral health. Successful therapeutic | [
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approaches include cognitive behavioral(400,402,429,430) and mindfulness-basedtherapies (427,431,432). See the sectionsbelow for details about interventions forspecifi c psychological concerns. Behav- | [
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ioral interventions may also be indicatedin a preventive manner even in the ab-sence of positive psychosocial screeners,such as resilience-promoting interventions\nto prevent diabetes distress in adoles- | [
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cence (433,434) and behavioral familyinterventions to promote collaborative fam-ily diabetes management in early adoles-cence (435,436) or to support adjustmentto a new treatment plan or technology(65). Psychosocial interventions can be de-livered via digital health platforms (437).Group-based or shared diabetes appoin... | [
-0.09757684916257858,
-0.0012496660929173231,
-0.06278405338525772,
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0.036861810833215714,
0.08072327077388763,
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-0.027680600062012672,
0.027133958414196968,
-0.0327756442129612,
-0.07899124175310135,
-0.0... |
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