Diabetes Distress: Living with Diabetes, By Bela Patel

Bela Patel, MSN, CRNP, NP-C

November is Diabetes Awareness Month. Approximately 30.3 million people in the United States live with diabetes. Diabetes is a chronic condition that requires patients to be rigorous in their self-management to achieve optimal health outcomes and prevent diabetes-related complications.

While many have heard about diabetes, it is important to also discuss diabetes distress, which is something patients can experience due to the lifestyle changes and daily management individuals with diabetes face.

Diabetes management involves checking blood glucose multiple times in a day, diet modification, increasing physical activity, medication adherence, and insulin dosage adjustment. These changes in lifestyle can lead to distress for individuals with diabetes. Working with patients, I see the overwhelming burden that patients sometime experience. The health care providers at this clinic also see that it is not always depression that these patients are experiencing, but instead it is the impact of the stress that comes with diabetes management.

It is essential for health care providers to be aware of patients’ emotional state, and to do this there is a Diabetes Distress Screening Tool that can be used. It measures stress, worry, guilt, or burden that the patients with diabetes experience due to the daily management of their condition. Many of us are aware of depression, but much less is known about diabetes distress. It is distinct from depression, and can affect the patient’s quality of life and their adherence to treatment plans impacting their health outcomes, such as glycemic control.

How can we assess for diabetes distress?

American Diabetes Association emphasizes the importance of assessing patients for symptoms of diabetes distress and encourages the integration of psychological care into primary care practices. The Diabetes Distress Screening Scale is a reliable 17-item screening scale that is widely used throughout the world. The four factors — Emotional Burden, Regimen Distress, Interpersonal Distress, and Physician Distress — capture the different types of distress that patients can experience.

  1. Emotional burden: Focuses on feelings of being overwhelmed. Patients may state, “Diabetes has taken over my life, and nothing that I do can help my diabetes.”
  2. Regimen distress: Assesses patients’ feelings of failing at their daily regimen. Patients can report, “I am tired of checking my blood sugars every day,” or “I do not want to count carbohydrates anymore.”
  3. Interpersonal distress: Addresses patients’ feelings about not receiving adequate support from family and friends. Patients may indicate, “I have no one at home who can help manage insulin for me,” or “My mom is too involved in my care.”
  4. Physician-related distress: Emphasizes patients’ stress about not receiving expert health care or adequate direction and support from health care providers. Patients who screen high on the physician-related distress subscale lack the confidence in their health care providers on their knowledge of diabetes.

What can you do??

We see that the prevalence of diabetes distress is increasing, making it essential to spread awareness of psychological factors that can affect the patient’s ability to adhere to their daily diabetes management. If you know someone who has diabetes and seems distressed with managing their health, ask them to talk to their primary care provider/endocrinologist about diabetes distress. Encourage them to enquire about a meeting with a diabetes educator or a behavioral health counselor and consider joining a diabetes support group.

If you are a health care provider, educate your patients about diabetes distress and empower them to be actively involved in their care; ask open-ended questions and encourage them to express their feelings; and work towards shared decision making. And finally, consider the integration of behavioral health into your primary care practice.

For additional information on Diabetes Distress:

Bela Patel, MSN, CRNP, NP-C, is an instructor in the UAB School of Nursing BSN program. She has experience in geriatrics, diabetes, medical-surgical, and gynecology/oncology, and she maintains her faculty practice as a nurse practitioner in the School’s PATH clinic, where she provides care for indigent patients with diabetes. Patel earned her Master’s of Science in Nursing from UAB School of Nursing in 2014 and is working to receive her Doctor of Nursing Practice (DNP).



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