Prioritizing Mental Health in Diabetes Care
By Matthew Garza
A1C. Time in range. Cholesterol levels. Weight. Blood Pressure. Lipids. When you think of the things that you talk to your healthcare team about, these metrics probably rise to the top of the list. But how often does your healthcare provider ask you about your mental health? What about diabetes distress or the stigma you may be facing? How often does your healthcare provider ask you the simple question: “How are you?”
Common health metrics like A1C are important. They help paint a picture of diabetes management, overall health, and risk for short-term and long-term complications. But, alone, they don’t tell the full story.
At the inaugural Research Accelerating Psychosocial Innovations in Diabetes (RAPID) Conference this November in Copenhagen, Denmark, type 2 diabetes advocate Walther Jensen said in his presentation that there are two sides to a diabetes diagnosis: the clinical side and the psychological side.
Jensen was diagnosed with type 2 diabetes in 2014 and currently works in film and advertising in Denmark. He’s a member of several patient advocacy groups and has a particular interest in improving communication between healthcare providers and newly diagnosed people with diabetes. The reason for this interest? People deserve to be better informed when they are first diagnosed, especially around the connection between mental health and diabetes. Jensen knows this firsthand.
When he was first diagnosed, Jensen was overwhelmed by the sheer amount of information coming his way — and confused as to what was true and what was misleading. Though his healthcare team was helpful, he wishes they had done a better job pointing him in the right direction. It might have helped him manage the emotional challenges of being diagnosed with a condition that would completely change the way he lived his life, and one that is fraught with myths, misinformation, and false promises of a cure.
However, Jensen was keen on reframing his diagnosis and finding ways to filter out the misleading claims. Instead of seeing it as a burden, he recognized the ways diabetes helped him change his lifestyle in a positive way. “My diagnosis was actually a lifeline for me,” he said.
He sought out information, joined patient advocacy groups, and participated in workshops and research groups to help him better understand diabetes and improve healthcare for others. He eventually realized that, “Having diabetes is so much more than [managing] blood sugar levels,” he said. “It becomes a part of your identity.”
Jensen’s words ring particularly true for Professor Jane Speight, director of the Australian Centre for Behavioural Research in Diabetes (ACBRD) in Victoria. In her keynote presentation at the 2022 RAPID conference, she called attention to the fact that even though we know that mental health is a major challenge in diabetes care — from battling diabetes stigma to diabetes distress — it’s almost never prioritized in clinical care for people with diabetes.
That’s part of the reason that the RAPID conference was created, to shine a light on the mental health and psychosocial aspects of diabetes and bring together researchers, healthcare providers, and people with diabetes who are working to address these challenges.
One of the key areas for improvement highlighted by Speight is the clinician-patient relationship. She introduced the idea by quoting one of the world’s foremost diabetes experts, Bill Polonsky: “The clinician-patient relationship is the least explored complication of diabetes.” Research shows that people with diabetes feel isolated, alone, and judged by their healthcare providers. They’re searching for someone who is an advocate for them, someone who is on their side.
Currently, the majority of people with diabetes are not reaching their healthcare targets for metrics like A1C or blood pressure. Communication gaps that leave people with diabetes lost while looking for information, or judgment that makes them hesitate to trust their healthcare team, contribute to this issue.
Speight made sure to emphasize this, sharing responses gathered from her research. Study participants were asked to finish the statement: “I wish my health professional understood…” The responses indicated that people with diabetes felt unsupported and judged by their healthcare team.
The way to address this is to give healthcare professionals the tools they need to deliver compassionate care and to encourage them to prioritize psychosocial aspects of diabetes care.
Speight highlighted several resources available to healthcare providers:
The National Diabetes Services Scheme’s guide, “Diabetes and Emotional Health,” helps healthcare professionals identify, address, and communicate about emotional health with people with diabetes.
The guide includes summary cards that give actionable tips to healthcare professionals to better help people manage the mental and emotional challenges of diabetes.
The American Diabetes Association has a US version of this guide, “Diabetes and Emotional Health.”
dStigmatize is an online resource that helps educate people on diabetes stigma.
Speight also highlighted resources for people living with diabetes:
These are the exact types of tools that Jensen said he wished he had been directed to when first diagnosed. According to Speight, people with diabetes should expect to be asked about the psychosocial aspects of their diabetes at every appointment — and advocate for themselves if they aren't.
For more information on the psychosocial aspects of diabetes and the importance of mental health care, explore diaTribe’s resources on mental health.