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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... | [
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ments that address both medical and psy-\nchosocial issues relevant to living withdiabetes are a promising model to consider(397,438).\nAlthough ef ficacy has been demon- | [
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Although ef ficacy has been demon-\nstrated with psychosocial interventions,there has been varying success regardingsustained increases in engagement in healthbehaviors and improved glycemic outcomesassociated with behavioral health issues.\nThus, health care professionals should | [
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Thus, health care professionals should\nsystematically monitor these outcomesfollowing implementation of current ev-idence-based psychosocial treatmentsto determine ongoing needs.\nDiabetes Distress\nRecommendation\n5.39 Screen people with diabetes, care-\ngivers, and family members for diabetes\ndistress at least annu... | [
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distress at least annually, and consider\nmore frequent monitoring when treat-\nment targets are not met, at transi-\ntional times, and/or in the presence of\ndiabetes complications. Health careprofessionals can address diabetes dis-\ntress and may consider referral to aqualified behavioral health professional, | [
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ideally one with experience in diabetes,for further assessment and treatment ifindicated. B\nDiabetes distress is very common (391,\n439–441). While it shares some features\nwith depression, diabetes distress is dis-\ntinct and has unique relationships with\nglycemic and other outcomes (440,442).\nDiabetes distress ref... | [
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Diabetes distress refers to signi ficant\nnegative psychological reactions relatedto emotional burdens and worries speci fic\nto an individual ’s experience in having to\nmanage a severe, complicated, and de-\nmanding chronic condition such as diabetes\n(439,440,443). The constant behavioral\ndemands of diabetes self-man... | [
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demands of diabetes self-management\n(medication dosing, frequency, and\ntitration as well as monitoring of glu-\ncose, food intake, eating patterns, and\nphysical activity) and the potential or\nactuality of disease progression are di-\nrectly associated with reports of diabe-\ntes distress (439). The prevalence of\nd... | [
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diabetes distress is reported to be\n18–45%, with an incidence of 38 –48%\nover 18 months in people with type 2diabetes (443). In the second Diabetes\nAttitudes, Wishes, and Needs (DAWN2)\nstudy, signi ficant diabetes distress was re-\nported by 45% of the participants, butonly 24% reported that their health care\nteams... | [
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teams asked them how diabetes affected\ntheir lives (391). Similar rates have been\nidenti fied among adolescents with type 1\ndiabetes (441) and in parents of youthwith type 1 diabetes. High levels of diabe-\nt e sd i s t r e s ss i g n i ficantly impact medication-\ntaking behaviors and are linked to higherA1C, lower s... | [
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0.008957569487392902,
-0.023999914526939392,
-0.018750745803117752,
0.09252721071243286,
0.13840459287166595,
-0.028608163818717003,
-0.044921670109033585,
-0.036771371960639954,
0.06548857688903809,
-0.05245737358927727,
0.0... |
Table 5.2 —Situations that warrant referral of a person with diabetes to a quali fied behavioral health professional for\nevaluation and treatment\n/C15A positive screen on a validated screening tool for depressive symptoms, diabetes distress, anxiety, fear of hypoglycemia, suicidality, or\ncognitive impairment | [
-0.034894175827503204,
0.055652569979429245,
-0.06394138932228088,
0.04746253415942192,
-0.0035666106268763542,
0.06286167353391647,
0.07484626770019531,
0.05858096480369568,
-0.07714289426803589,
0.0048165093176066875,
-0.01230331789702177,
-0.017404351383447647,
-0.06016744673252106,
-0.... |
cognitive impairment\n/C15The presence of symptoms or suspicions of disordered eating behavior, an eating disorder, or disrupted patterns of eating\n/C15Intentional omission of insulin or oral medication to cause weight loss is identi fied\n/C15A serious mental illness is suspected | [
0.010245940648019314,
0.07086247950792313,
-0.029833709821105003,
0.0621136911213398,
-0.017239809036254883,
0.03543943166732788,
0.09648565202951431,
0.09684713184833527,
-0.04895412549376488,
0.0059952097944915295,
0.029972543939948082,
-0.02652512490749359,
-0.04509758576750755,
-0.0365... |
/C15A serious mental illness is suspected\n/C15In youth and families with behavioral self-care dif ficulties, repeated hospitalizations for diabetic ketoacidosis, failure to achieve expected\ndevelopmental milestones, or signi ficant distress | [
-0.04499155655503273,
0.05296788364648819,
-0.04993802681565285,
0.009838124737143517,
0.0019115523900836706,
0.020063145086169243,
0.032894331961870193,
0.07229229062795639,
-0.0014626188203692436,
-0.017891449853777885,
0.011594623327255249,
-0.0464298389852047,
-0.10858666151762009,
-0.... |
developmental milestones, or signi ficant distress\n/C15Low engagement in diabetes self-management behaviors, including declining or impaired ability to perform diabetes self-management behaviors | [
0.024377280846238136,
0.0503084771335125,
-0.052183445543050766,
0.08693922311067581,
-0.054365284740924835,
0.018132027238607407,
0.029882924631237984,
0.0698707327246666,
-0.03079834207892418,
-0.05116276070475578,
0.028002122417092323,
-0.005764020141214132,
-0.09580888599157333,
0.0337... |
/C15Before undergoing bariatric or metabolic surgery and after surgery, if assessment reveals an ongoing need for adjustment supportdiabetesjournals.org/care Facilitating Positive Health Behaviors and Well-being S93\n©AmericanDiabetesAssociation | [
-0.07281418889760971,
-0.0019922491628676653,
-0.03577294573187828,
0.09233849495649338,
0.013292414136230946,
0.02359873242676258,
0.016970612108707428,
0.03352588415145874,
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0.00... |
eating and exercise behaviors (5,439,443).\nDiabetes distress is also associated withsymptoms of anxiety, depression, and re-duced health-related quality of life (444).\nDiabetes distress should be routinely\nmonitored (445) using diabetes-speci fic\nvalidated measures (1), such as thosea v a i l a b l et h r o u g ht h... | [
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0.03081364557147026,
-0.04997491464018822,
0.08507244288921356,
-0.07049435377120972,
0.0308695025742054,
0.07591520994901657,
0.03144807741045952,
-0.057211924344301224,
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-0.09155244380235672,
0.021230565384030342,
-0.09479765594005585,
-0.052529... |
(professional.diabetes.org/sites/default/files/media/ada_mental_health_toolkit_\nquestionnaires.pdf). As there are diabe-tes distress measures that are validatedfor people with type 1 and type 2 diabe-tes at different life stages, it is important\nto select a tool that is appropriate for | [
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0.019543088972568512,
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0.019688377156853676,
-0.06136729568243027,
-0.03153875097632408,
0.1020168885588646,
0.07751742005348206,
-0.018029430881142616,
-0.032881900668144226,
-0.05087218061089516,
-0.0505257174372673,
-0.11109946668148041,
0.0321... |
to select a tool that is appropriate for\neach person or population. If diabetes dis-t r e s si si d e n t i fied, it should be acknowl-\nedged and addressed. If indicated, the\nperson should be referred for follow-up\ncare (403). This may include speci ficd i a b e - | [
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0.07953094691038132,
-0.05595835670828819,
-0.007002202793955803,
-0.07321334630250931,
0.011624307371675968,
0.11759360879659653,
0.08252128213644028,
0.004361636471003294,
-0.024128369987010956,
0.04211203008890152,
-0.06672707945108414,
-0.013013992458581924,
-0.00... |
care (403). This may include speci ficd i a b e -\ntes education to address areas of diabetesself-care causing distress and impactingclinical management and/or behavioral\nintervention from a quali fied behavioral\nhealth professional, ideally one with exper-\ntise in diabetes, or from another trainedhealth care professi... | [
-0.026641923934221268,
0.08854849636554718,
-0.07195141166448593,
0.007227390538901091,
-0.04819468781352043,
0.016829311847686768,
0.07005898654460907,
0.019764643162488937,
-0.019380031153559685,
-0.010458311066031456,
-0.023348184302449226,
0.013274310156702995,
-0.07602905482053757,
-0... |
and behavioral intervention strategies have\ndemonstrated bene fits for diabetes dis-\ntress and, to a lesser degree, glycemicoutcomes, including education, psychologi-\ncal therapies, such as cognitive behavioral | [
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0.06002495065331459,
-0.04225533455610275,
0.03667192533612251,
-0.06936784833669662,
0.06512464582920074,
0.06779201328754425,
0.08002205193042755,
-0.028727859258651733,
0.0018916272092610598,
-0.03602452948689461,
0.07011739909648895,
-0.047963257879018784,
0.00503... |
cal therapies, such as cognitive behavioral\ntherapy (CBT) and mindfulness-basedtherapies, and health behavior changeapproaches, such as motivational interview-ing (429,430,446,447). Data support diabe-\ntes distress interventions delivered using | [
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0.0751817524433136,
0.008629255928099155,
0.01552607398480177,
-0.015395467169582844,
0.057969991117715836,
0.01011564489454031,
0.0729304701089859,
0.027318306267261505,
-0.052390895783901215,
-0.04762646555900574,
-0.03990346938371658,
-0.023089012131094933,
-0.0242... |
tes distress interventions delivered using\ntechnology to reduce diabetes distress(437), including phone-delivered CBT com-bined with a smartphone application for\nCBT (448). DSMES has been shown to re-\nduce diabetes distress (5) and may alsobenefit A1C when combined with peer sup-\nport (449). It may be helpful to pro... | [
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0.09422358870506287,
0.058751437813043594,
0.046276722103357315,
-0.014396531507372856,
0.040413644164800644,
0.035919226706027985,
0.18631409108638763,
-0.03346079960465431,
-0.06540189683437347,
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-0.0... |
port (449). It may be helpful to provide\ncounseling regarding expected diabetes-\nrelated versus generalized psychological dis-tress, both at diagnosis and when diseasestate or treatment changes occur (450). Amultisite RCT with adults with type 1 dia-\nbetes and elevated diabetes distress and | [
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0.031519267708063126,
-0.029565483331680298,
0.04233874753117561,
-0.026938125491142273,
0.01735985279083252,
0.026209579780697823,
0.16024798154830933,
-0.05508767440915108,
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0.02... |
betes and elevated diabetes distress and\nA1C demonstrated large improvements indiabetes distress and small reductions inA1C through two 3-month intervention ap-\nproaches: a diabetes education interven-\ntion with goal setting and a psychologicalintervention that included emotion regu-lation skills, motivational inter... | [
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0.06429789215326309,
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0.0869000107049942,
-0.028373578563332558,
0.04260784760117531,
0.09223351627588272,
0.07224641740322113,
0.0007961505325511098,
-0.0032441490329802036,
-0.08452752232551575,
0.01229056902229786,
-0.07270195335149765,
-0.04933... |
and goal setting (451). Among adults with\ntype 2 diabetes in the Veterans Affairs sys-tem, an RCT demonstrated bene fits ofintegrating a single session of mindfulness | [
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0.1201384961605072,
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0.02612999826669693,
0.06105877086520195,
0.04471936076879501,
0.07622060179710388,
0.02700575813651085,
0.030103320255875587,
-0.03907180577516556,
-0.05430779233574867,
0.01958494633436203,
0.021182920783758163,
-0.00381865... |
intervention into DSMES, followed by abooster session and mobile app-basedhome practice over 24 weeks, with thestrongest effects on diabetes distress(452). An RCT of CBT demonstrated posi-tive bene fits for diabetes distress, A1C, | [
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0.04278896003961563,
0.04050475358963013,
0.04646093770861626,
-0.030406881123781204,
0.02202017605304718,
0.055711984634399414,
0.18607737123966217,
0.0037431218661367893,
-0.06355171650648117,
-0.11446380615234375,
0.0021583596244454384,
-0.02500148117542267,
-0.041... |
and depressive symptoms for up to 1 yearamong adults with type 2 diabetes and el-evated symptoms of distress or depres-sion (453). An RCT among people withtype 1 and type 2 diabetes found mindfulself-compassion training increased self-compassion, reduced depression and dia-betes distress, and improved A1C (454).An RCT ... | [
-0.04422963038086891,
0.017991099506616592,
-0.04590946435928345,
0.10137408971786499,
0.04172279313206673,
0.018776651471853256,
0.018913013860583305,
0.10419480502605438,
0.0023969553876668215,
-0.08569203317165375,
-0.08547250181436539,
0.06643150001764297,
-0.04601721465587616,
0.02061... |
distress, and improved A1C (454).An RCT of a resilience-focused cognitivebehavioral and social problem-solving | [
0.03403894230723381,
0.04621608182787895,
-0.031766705214977264,
0.04054586589336395,
0.013952852226793766,
0.10703977942466736,
0.006820241454988718,
0.13779976963996887,
-0.0026812180876731873,
0.007651445455849171,
-0.020952727645635605,
0.016139991581439972,
0.012303316965699196,
-0.00... |
intervention compared with diabetes ed-\nucation (434) in teens with type 1 diabe-tes showed that diabetes distress anddepressive symptoms were signifi cantly | [
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0.07429050654172897,
0.0225836131721735,
0.05876104161143303,
-0.04277472943067551,
-0.018901122733950615,
0.04265272244811058,
0.05244755744934082,
0.0009920226875692606,
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0.051405828446149826,
-0.0534268356859684,
0.00396... |
reduced for up to 3 years post-interven-tion, although neither A1C nor self-management behaviors improved overtime. These recent studies support that acombination of educational, behavioral,and psychological intervention approachesis needed to address distress, depression,and A1C.\nAs with treatment of other diabetes- | [
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0.04028527811169624,
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0.09150581061840057,
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0.03723311051726341,
-0.0025781376753002405,
0.0825241208076477,
0.007674302905797958,
0.004855375271290541,
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0.08623195439577103,
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0.000275... |
As with treatment of other diabetes-\nassociated behavioral and psychosocialfactors affecting disease outcomes, thereare few outcome data on long-term sys-\ntematic treatment of diabetes distress\nintegrated into routine care. As the dia-betes disease course and its manage-ment are fluid, it can be expected that\nrelate... | [
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0.042798228561878204,
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0.0567016527056694,
0.06544782221317291,
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0.014792... |
related distress may fluctuate and may\nneed different methods of remediationat different points in the life course andas disease progression occurs.\nAnxiety\nRecommendation\n5.40 Consider screening people with\ndiabetes for anxiety symptoms, fear of\nhypoglycemia, or diabetes-related wor-\nries. Health care profession... | [
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0.0792340561747551,
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0.04992400482296944,
0.045872267335653305,
-0.07061312347650528,
-0.04126911610364914,
-0.045639827847480774,
0.047828689217567444,
-0.0466286763548851,
0.020392... |
ries. Health care professionals can dis-\ncuss diabetes-related worries andshould consider referral to a quali fied\nbehavioral health professional for fur-ther assessment and treatment if anxi-ety symptoms indicate interferencewith diabetes self-management behav-iors or quality of life. B\nAnxiety symptoms and diagnosa... | [
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0.06423697620630264,
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0.12240172177553177,
0.07273589819669724,
0.0002710422268137336,
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0.0016789495712146163,
-0.046013250946998596,
0.... |
Anxiety symptoms and diagnosable dis-\norders (e.g., generalized anxiety disorder,body dysmorphic disorder, obsessive\ncompulsive disorder, speci fic phobias,\nand posttraumatic stress disorder) are\ncommon in people with diabetes (455).\nThe Behavioral Risk Factor Surveillance\nSystem estimated the lifetime preva- | [
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-0.04268800839781761,
0.09328165650367737,
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0.02066698484122753,
0.09491705894470215,
0.05202830582857132,
-0.03083709254860878,
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0.010484680533409119,
0.018943533301353455,
-0.03098716028034687,
-0.0090592... |
System estimated the lifetime preva-\nlence of generalized anxiety disorder to\nbe 19.5% in people with either type 1 or\ntype 2 diabetes (456). A common diabe-\ntes-speci fic concern is fear related to hypo-\nglycemia (457 –459), which may explain\navoidance of behaviors associated withlowering glucose, such as increas... | [
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0.08823880553245544,
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0.1327943056821823,
0.06430613249540329,
-0.008993412367999554,
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-0.06441175937652588,
0.02354835718870163,
-0.011871499009430408,
-0.039499... |
doses or frequency of monitoring. Factors\nrelated to greater fear of hypoglycemia in\npeople with diabetes and family members\ninclude history of nocturnal hypoglycemia,\npresence of other psychological concerns,\nand sleep concerns (460). See Section 6,\n“Glycemic Goals and Hypoglycemia, ”for | [
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0.10410740971565247,
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0.08983239531517029,
0.040530119091272354,
0.05853590369224548,
0.060465794056653976,
0.07689940929412842,
-0.0025464061181992292,
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0.00210... |
“Glycemic Goals and Hypoglycemia, ”for\nmore information about impaired aware-ness of hypoglycemia and related fear ofhypoglycemia. Other common sources of\ndiabetes-related anxiety include not\nmeeting blood glucose targets (455), in-\nsulin injections or infusion (461), and on-\nset of complications (1). People with | [
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0.08120280504226685,
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0.040489956736564636,
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0.031012460589408875,
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-0.110... |
set of complications (1). People with\ndiabetes who exhibit excessive diabetes\nself-management behaviors well beyond\nwhat is prescribed or needed to achieve\nglycemic goals may be experiencingsymptoms of obsessive-compulsive disor-\nder (462). General anxiety is a predictor\nof injection-related anxiety and is associ... | [
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0.08057352155447006,
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0.13862426578998566,
0.0667535737156868,
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0.03045925311744213,
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of injection-related anxiety and is associ-\nated with fear of hypoglycemia (458,463).\nPsychological and behavioral care can\nbe helpful to address symptoms of anxietyin people with diabetes. Among adults\nwith type 2 diabetes and elevated depres-\nsive symptoms, an RCT of collaborative\ncare demonstrated benefi ts on ... | [
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0.08171389997005463,
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0.1249932199716568,
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0.10701895505189896,
0.046536896377801895,
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-0.0706360712647438,
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0.04383416846394539,
-0.0023687053471803665,
-0.04314... |
care demonstrated benefi ts on anxiety\nsymptoms for up to 1 year (464). An RCTof CBT for adults with type 2 diabetes\nshowed a reduction in health anxiety,\nwith CBT accounting for 77% of the re-duction in health anxiety at 16 weeks of\nfollow-up; this trial also found decreased\ndepressive symptoms and diabetes dis- | [
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0.06716565787792206,
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0.11516842246055603,
-0.00453929603099823,
0.0509255975484848,
0.047280728816986084,
0.09037844091653824,
-0.011740888468921185,
-0.09741491079330444,
-0.10562046617269516,
0.023722702637314796,
0.014012394472956657,
-0.08... |
depressive symptoms and diabetes dis-\ntress (465). Additionally, an RCT showed\nswitching from intermittently scanned\nCGM without alerts to real-time CGM\nwith alert functionality in adults with\ntype 1 diabetes decreased hypoglyce-\nmia-related anxiety at 24 months offollow-up while reducing A1C (466).\nThus, specia... | [
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0.07579028606414795,
-0.025464830920100212,
0.12680576741695404,
0.0164975356310606,
0.037472113966941833,
0.06946616619825363,
0.11404187977313995,
-0.004167573060840368,
-0.02228708006441593,
-0.09506645053625107,
0.03870007395744324,
-0.01611819863319397,
-0.041036... |
Thus, specialized behavioral intervention\nfrom a quali fied professional is needed\nto treat hypoglycemia-related anxiety.S94 Facilitating Positive Health Behaviors and Well-being Diabetes Care Volume 47, Supplement 1, January 2024\n©AmericanDiabetesAssociation | [
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0.02872157096862793,
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0.013... |
Depression\nRecommendations\n5.41 Conduct at least annual screening\nof depressive symptoms in all people\nwith diabetes and more frequently\namong those with a self-reported his-tory of depression. Use age-appropriate,\nv a l i d a t e dd e p r e s s i o ns c r e e n i n gm e a s - | [
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0.10111348330974579,
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0.05490743741393089,
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0.10073632746934891,
0.035535041242837906,
0.07887829095125198,
-0.1038317009806633,
0.011508552357554436,
-0.029628721997141838,
-0.02059783600270748,
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v a l i d a t e dd e p r e s s i o ns c r e e n i n gm e a s -\nures, recognizing that further evaluationwill be necessary for individuals whoh a v eap o s i t i v es c r e e n . B\n5.42 Beginning at diagnosis of compli-\ncations or when there are signi ficant\nchanges in medical status, consider as-sessment for depress... | [
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changes in medical status, consider as-sessment for depression. B\n5.43 Refer to quali fied behavioral\nhealth professionals or other trained\nhealth care professionals with experi-\nence using evidence-based treatmentapproaches for depression in conjunc-\ntion with collaborative care with the\ndiabetes treatment team. ... | [
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tion with collaborative care with the\ndiabetes treatment team. A\nHistory of depression, current depres-\nsion, and antidepressant medication use\nare risk factors for the development oftype 2 diabetes, especially if the individ-\nual has other risk factors, such as obesity\nand family history of type 2 diabetes(467– ... | [
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and depressive disorders are common\namong people with diabetes (385,459), af-\nfecting approximately one in four peoplewith type 1 or type 2 diabetes (390), andamong parents of youth with diabetes\n(470). Thus, routine screening for depres- | [
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(470). Thus, routine screening for depres-\nsive symptoms is indicated in this high-riskpopulation, including people with type 1or type 2 diabetes, gestational diabetes\nmellitus, and postpartum diabetes. Re-\ngardless of diabetes type, women havesignificantly higher rates of depression\nthan men (471).\nRoutine monitor... | [
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than men (471).\nRoutine monitoring with age-appropri-\nate validated measures (1) can help toidentify if referral is warranted (403,410).Multisite studies have demonstrated feasi-bility of implementing depressive symp-\ntom screening protocols in diabetes clinics\nand published practical guides for imple-mentation (40... | [
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history of depressive symptoms need on-going monitoring of depression recurrencewithin the context of routine care (467). In-tegrating behavioral and physical health\ncare can improve outcomes. When a per-\nson with diabetes is receiving psychologicaltherapy, the behavioral health professionalshould be incorporated int... | [
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with the diabetes treatment team (473).As with DSMES, person-centered collabora-\ntive care approaches have been shown to\nimprove both depression and medical out-\ncomes (473). Depressive symptoms may\nalso be a manifestation of reduced quality\nof life secondary to disease burden (also\nsee\nDIABETES DISTRESS , above... | [
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see\nDIABETES DISTRESS , above) and resultant\nchanges in resource allocation impactingthe person and their family. When de-pressive symptoms are identi fied, it is\nimportant to query origins, both diabetes-specifi c ones and those due to other life\ncircumstances (444,474).\nTrials have shown consistent evidence of\nim... | [
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improvements in depressive symptoms\nand variable bene fits for A1C when depres-\nsion is simultaneously treated (401,473,475), whether through pharmacological\ntreatment, group therapy, psychotherapy,\nor collaborative care (398,429,430,476,\n477). Psychological interventions targetingdepressive symptoms have shown effi... | [
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when delivered via digital technologies(478). A systematic review of internet-\ndelivered CBT studies indicated bene fits\nacross chronic health conditions, includingdiabetes (479). For people with diabetes,\nan RCT comparing internet plus tele-\nphonic CBT to usual care found moderate | [
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phonic CBT to usual care found moderate\nto large improvements in depressivesymptoms at 12 months (480). Physical\nactivity interventions also demonstrate\nbenefits for depressive symptoms and\nA1C (318). It is important to note that themedical treatment plan should also be\nmonitored in response to reduction in de-\npr... | [
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monitored in response to reduction in de-\npressive symptoms.\nDisordered Eating Behavior\nRecommendations\n5.44 Consider screening for disor-\ndered or disrupted eating using vali-\ndated screening measures whenhyperglycemia and weight loss areunexplained based on self-reported\nbehaviors related to medication dos- | [
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behaviors related to medication dos-\ning, meal plan, and physical activity.In addition, a review of the medicaltreatment plan is recommended toidentify potential treatment-related\neffects on hunger/caloric intake. B\n5.45 Consider reevaluating the treat-\nment plan of people with diabetes | [
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ment plan of people with diabetes\nwho present with symptoms of disor-dered eating behavior, an eating dis-order, or disrupted patterns of eating,in consultation with a quali fiedprofessional. Key quali fications include\nfamiliarity with diabetes disease physi- | [
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familiarity with diabetes disease physi-\nology, treatments for diabetes and dis-ordered eating behaviors, and weight-related and psychological risk factorsfor disordered eating behaviors. B\nEstimated prevalence of disordered eat-\ning behavior and diagnosable eating dis-\norders in people with diabetes varies\n(481–4... | [
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(481–483). For people with type 1 diabe-\ntes, insulin omission causing glycosuria\nin order to lose weight is the most com-\nmonly reported disordered eating be-\nhavior (484,485); in people with type 2diabetes, bingeing (excessive food intake\nwith an accompanying sense of loss of | [
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with an accompanying sense of loss of\ncontrol) is most commonly reported. Forpeople with type 2 diabetes treated with\ninsulin, intentional omission is also fre-\nquently reported (486). People with dia-betes and diagnosable eating disorders\nhave high rates of comorbid psychiatric\ndisorders (487). People with type 1... | [
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disorders (487). People with type 1 dia-\nbetes and eating disorders often have\nhigh rates of diabetes distress and fearof hypoglycemia (488).\nDiabetes care professionals should\nmonitor for disordered eating behaviorsusing validated measures (489). Whenevaluating symptoms of disordered or\ndisrupted eating (when the... | [
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0... |
disrupted eating (when the individual ex-\nhibits eating behaviors that appear mal-adaptive but are not volitional, such as\nbingeing caused by loss of satiety cues),\netiology and motivation for the behavior\nshould be evaluated (483,490). Mixed in-\ntervention results point to the need fortreatment of eating disorder... | [
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dered eating behavior in the context of\nthe disease and its treatment. Given thecomplexities of treating disordered eating\nbehaviors and disrupted eating patterns\nin people with diabetes, it is recom-mended that interprofessional care teams\ninclude or collaborate with a health pro- | [
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include or collaborate with a health pro-\nfessional trained to identify and treat eat-ing behaviors with expertise in disordered\neating and diabetes (491). Key quali fica-\ntions for such professionals include famil-\niarity with diabetes disease physiology,\nweight-related and psychological risk fac-\ntors for disord... | [
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tors for disordered eating behaviors, and\ntreatments for diabetes and disordered\neating behaviors. More rigorous methodsto identify underlying mechanisms of ac-\ntion that drive change in eating and treat-\nment behaviors, as well as associateddiabetesjournals.org/care Facilitating Positive Health Behaviors and Well-... | [
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©AmericanDiabetesAssociation | [
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mental distress, are needed (492). Health\ncare teams may consider the appropriate-ness of technology use among peoplewith diabetes and disordered eating be-haviors, although more research on therisks and bene fits is needed (493). Cau-\ntion should be taken in labeling individu-a l sw i t hd i a b e t e sa sh a v i n g... | [
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psychiatric disorder, i.e., an eating disor-\nder, when disordered or disrupted eatingpatterns are found to be associated withthe disease and its treatment. In otherwords, patterns of maladaptive food in-take that appear to have a psychologicalorigin may be driven by physiologic dis-ruption in hunger and satiety cues, ... | [
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bolic perturbations, and/or secondary\ndistress because of the individual ’s inabil-\nity to control their hunger and satiety(483,490).\nThe use of incretin therapies may have\npotential relevance to the treatment ofdisrupted or disordered eating (see Sec-tion 8, “Obesity and Weight Management | [
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for the Prevention and Treatment ofType 2 Diabetes ”). Incretin therapies work\nin the appetite and reward circuitries tomodulate food intake and energy bal-ance, reducing uncontrollable hunger,overeating, and bulimic symptoms (494),although mechanisms are not completelyunderstood (495). Weight loss from these\nmedicat... | [
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medications (496) may also improve\nquality of life. More research is neededabout whether use of incretins andother medications affects physiologi-cally based eating behavior in peoplewith diabetes.\nSerious Mental Illness\nRecommendations\n5.46 Provide an increased level of\nsupport for people with diabetes and | [
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support for people with diabetes and\nserious mental illness through en-hanced monitoring of and assistancewith diabetes self-management be-haviors. B\n5.47 Monitor changes in body weight,\nglycemia, and lipids in adolescents and\nadults with diabetes who are prescribed | [
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adults with diabetes who are prescribed\nsecond-generation antipsychotic medi-cations; adjust the treatment plan ac-cordingly, if needed. C\nStudies of individuals with serious mental\nillness, particularly schizophrenia and other\nthought disorders, show signi ficantly in-\ncreased rates of type 2 diabetes (497).People... | [
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thought disorders who are prescribed anti-psychotics should be monitored for predia-\nbetes and type 2 diabetes because of the\nknown comorbidity. Changes in body\nweight, glycemia, and lipids should be\nmonitored every 12 –16 weeks, unless clini-\ncally indicated sooner (498). Disorderedthinking and judgment can be ex... | [
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make it dif ficult to engage in behavior that\nreduces risk factors for type 2 diabetes,such as restrained eating for weight man-\nagement. Further, people with serious be-\nhavioral health disorders and diabetes\nfrequently experience moderate psycho-logical distress, suggesting pervasive intru-\nsion of behavioral hea... | [
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-0.016333600506186485,
-0.008560673333704472,
-0.01761176995933056,
-0.09591847658157349,
0.00510865... |
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