Diabetes and emotional health - a practical guide for healthcare professionals supporting adults with Type 1 and Type 2 diabetes
This guide is for healthcare professionals working with people with Type 1 and Type 2 diabetes who are experiencing emotional difficulties. It offers strategies and tools for how to recognise and have conversations about emotional problems, as well as for providing appropriate support.
This guide was originally developed by the Australian Centre for Behavioural Research in Diabetes (ACBRD), the National Diabetes Services Scheme (NDSS) and Diabetes Australia in 2016, which is available to download from the NDSS website.
The UK edition (2019) of these guidelines were produced by Diabetes UK under a royalty-free, UK only, non-exclusive sub-license from Diabetes Australia.
You can find all the author acknowledgements, references, appendices, questionnaires and more in the full PDF guide.
For more information on language and diabetes, download the NHS England guide, Language Matters (PDF, 315KB)
or at ‘Language Matters Diabetes’, which showcases the worldwide Language Matters documents.
- Introduction to the guide
- Who this guide is for
- How to use this guide
- Leaflets for people with diabetes
- 7As model - what is it and how does it work?
- Chapter 1 – Communication and engagement
- Chapter 2 – Facing life with diabetes
- Chapter 3 – Diabetes distress
- Chapter 4 – Fear of hypoglycaemia (and other diabetes-specific fears)
- Chapter 5 – Psychological barriers to insulin use
- Chapter 6 – Depression
- Chapter 7 – Anxiety disorders
- Chapter 8 – Eating problems
- Chapter 9 – Referring to a mental health professional
Introduction to the guide
Diabetes self-management is demanding and complex. Activities such as monitoring blood glucose, injecting insulin, taking oral medications, regular physical activity, and healthy eating all require a comprehensive understanding of diabetes, as well as healthy coping, and skills in problem-solving and risk reduction. Diabetes is more than a physical health condition, it has behavioural, psychological, and social impacts, and demands high levels of self-efficacy, resilience, perceived control, and empowerment. Thus, it is unsurprising that living with diabetes negatively impacts upon the emotional well-being and quality of life of many people living with the condition.
Emotional and mental health problems (collectively referred to as psychological problems from here on), such as diabetes distress and depression, are common among adults with diabetes and are associated with sub-optimal self-management, diabetes-related complications, reduced quality of life, and increased health care costs. As noted by Jones and colleagues: ‘maintaining or achieving good psychological well-being and quality of life is an important outcome of diabetes care in its own right.’ This sentiment is shared by people with diabetes and health professionals, who recognise emotional health to be an important component of standard diabetes care.
Why is this guide needed?
‘We must move beyond the tendency to place an artificial divide between the emotional and the physical aspects of diabetes management that can lead to labelling the emotional aspects of diabetes a pathological condition. The two are so intertwined and interrelated that simply calling the emotional side a co-morbidity is counterproductive.’(Lawrence Fisher, Jeffrey Gonzalez and William Polonsky)
Given that separating psychological care from the context of diabetes self-management is rarely easy nor desirable, there is a strong argument that basic psychological care needs to be incorporated into diabetes care pathways, including assessment and treatment of the psychological problems frequently faced by people with diabetes. International guidelines reflect this view; recommending awareness and assessment of psychological problems in diabetes clinical practice.
Furthermore, the need for mental health care for people with diabetes is acknowledged in many of the UK National Diabetes Strategies, although often limited to anxiety and depression diagnoses.
Despite the numerous guidelines, and recognition by health professionals and Governments, the emotional and mental health needs of people with diabetes are often undetected and unmet in clinical practice. Furthermore, there is little evidence to demonstrate significant progress in the implementation of such recommendations. Health professionals cite lack of skills, confidence, time, and limited access to practical resources as common barriers. Whilst existing guidelines acknowledge the importance of psychological problems in diabetes and some make recommendations for assessing them, most fall short in providing guidance about how to incorporate this into the daily clinical practice setting. This guide is designed to complement and facilitate the implementation of existing guidelines.
The aim of this guide is to promote awareness of, and communication about, psychological problems affecting adults with diabetes. The objectives are to:
- raise awareness among health professionals of the prevalence and consequences of psychological problems among adults with diabetes
- provide a set of practice points for how to identify, communicate about, and address psychological problems with adults with diabetes in clinical practice
- foster skills development among health professionals for communicating about psychological problems in diabetes care, by providing examples of questions and responses, with case studies to demonstrate their implementation
- provide the practical tools (e.g. questionnaires, information leaflets, and other resources) to support health professionals in this endeavour