Quality Standards for Diabetes Care Toolkit

The National Institute for Health and Care Excellence (NICE) guidelines (2004) conclude children and young people with type 1 diabetes have a greater risk of emotional and behavioural problems than other children and young people. In particular, they are at higher risk of anxiety and depression, eating disorders, cognitive disorders, behaviour and conduct disorders and non-adherence. They highlight the importance of timely and ongoing access to mental health professionals for assessment of psychological dysfunction and the delivery of psychosocial support. In a study exploring the stress of parents of children with type 1 diabetes, Whittmore et al (2012) found that parents experience considerable stress related to the trauma of diagnosis and the demands of treatment management. Although many parents find ways to effectively manage this stress, others experience clinically significant levels of psychological distress, including symptoms of depression, anxiety, and posttraumatic stress. These symptoms have been shown to have negative effects on parenting, the child’s quality of life, and the child’s metabolic control. Therefore, screening and preventive interventions for parents as well as the child with diabetes are needed.
It is important to consider cultural variances in response to being diagnosed and living with a long term condition such as diabetes. Following her study exploring physical and psychological wellbeing among adults with type 2 diabetes in New Zealand, with a particular aim to identify the experiences of Pacific peoples, Paddison (2010) concluded that adults with type 2 diabetes who are young, overweight, have concerns about prescribed medications, and those of Pacific ethnicity, were most likely to experience adverse health outcomes, including poor metabolic control and diabetes-related distress. She concluded that among Pacific peoples in particular, there is a need to address concerns about medication and emotional distress about diabetes, while maintaining a focus on improving metabolic control.
For people with diabetes, it is important to make a distinction between depression and distress. According to Fisher et al (2012), diabetes distress (DD) ‘refers to the unique, often hidden emotional burdens and worries that are part of the spectrum of patient experience when managing a severe, demanding chronic disease like diabetes. High levels of DD are common (prevalence, 18–35%; 18-month incidence, 38–48%) and persistent over time, and they are distinct from clinical depression in their linkages with glycaemic control and disease management. High levels of DD have been significantly associated with poor glycaemic control, poor self-care, low diabetes self-efficacy, and poor quality-of-life, even after controlling for clinical depression’ (p 246).
Therefore, it is important to distinguish between depression and distress as different interventions will be required. According to Gonzalez et al (2011), a comprehensive approach ‘that distinguishes clinical depression from disease related distress and that offers support for the management of emotional distress as an integral part of providing support for the behavioural management of diabetes will have the greatest likelihood of clinical benefit for the vast majority of patients with diabetes’ (p 238).