ADA Calls for Integrating Psychosocial Care for People With Diabetes

The American Diabetes Association has called for fully integrating psychosocial care into diabetes treatment, ideally through a collaborative model that asks during the first visit after diagnosis whether a patient is experiencing depression or distress. The statement is published in the December issue of Diabetes Care.

Healthcare providers—who may often be primary care physicians—should revisit the mental health and cognitive status of persons with diabetes, “when there is a change in disease, treatment, or life circumstance.” The statement calls for bringing caregivers and family members into this process, and for monitoring a patient’s self-management skills as part of this evaluation.

The statement calls on providers to form partnerships or “alliances” with behavioral health professionals who are well versed in the needs of those with diabetes. Ideally, these partners “should be embedded in diabetes care settings.” A joint location will allow sharing of records, including electronic health data, and maximize the effort to improve the patient’s disease management.

Collaborative care, which calls for putting primary and behavioral healthcare under one roof, is not a new concept; it was pioneered by the University of Washington School of Medicine, and its success specifically for patients who had both diabetes and depression was presented in the New England Journal of Medicine in 2010. It has received increased attention in recent years due to the Affordable Care Act, which allowed the development of new payment models to support the practice. The 2017 Medicare Physician Fee Schedule will reimbursement collaborative care for the first time.

The ADA statement calls for:

• Taking into account cultural influences, and tailoring care to family influences.
• Monitoring patients for diabetes distress, which the statement says happens due to the constant demands of medication dosing and titration, and monitoring food intake and physical activity. Adolescents are particularly vulnerable to distress and may be less vigilant about self care.
• Screening patients for anxiety if they have hypoglycemia unawareness, and giving these patients blood glucose awareness training to reduce fear.
• Being aware of the potential for disordered eating. Providers should consider screening for disordered or disrupted eating when hyperglycemia and weight loss can’t be explained by self-reported behavior, medication dosing, or physical activity.

The position statement includes recommendations for different age groups, such as young adults and those age 65 and older; the latter group faces increased risk of dementia. Some adults in the primary care setting should be treated for comorbid depression, the statement said.

People with diabetes “must master many complex tasks and behaviors to successfully incorporate diabetes care into daily life,” the statement said. “Disease management cannot be successful unless the lifestyle and emotional status of the individual is taken into consideration.”

Unless providers consider the context that patients face while living with this chronic condition 24/7, they cannot expect successful self-management, the statement says, so including behavioral health into the equation from the beginning makes sense. Locating services in one place—which is not only convenient for patients but compels providers to consult with one another—offers the best possibility for success.

“Collaborative care shows the most promise for supporting physical and behavioral health outcomes.”

Reference

Young-Hyman D, de Groot M, Hill-Briggs F, et al. Psychosocial care for people with diabetes: a position statement from the American Diabetes Association. Diabetes Care. 2016; 39(12): 2126-2140. http://dx.doi.org/10.2337/dc16-2053