Psychology in diabetes care by Frank J. Snoek, T. Chas Skinner
Diabetes is a very human condition. Even to those of us with many years of clinical practice in diabetes, the infinite diversity of individual response to diabetes is a constant source of amazement but also professional enhancement. People are different and behave differently, and often unexpectedly. That is what makes involvement in diabetes care such a three-dimensional experience.
Diabetes and its consequences have a fundamental physical basis, but these are deeply intertwined with complex psychosocial issues. Such interrelationships are considerable, sometimes subtle; sometimes overwhelming.
Awareness of these issues is crucial to enabling people with diabetes to lead a healthy and fulfilled life. Empathy and appreciation of the psychosocial needs of patients are essential requirements for those involved in diabetes care, and indeed most do seem to acquire that intuitive understanding of patient-professional relationships so fundamental to good clinical care. But the world of psychology has progressed; much more is known and the evidence base of psychological management in diabetes care is becoming clearer.
Despite the widespread and increasing prevalence of diabetes in the population, the diagnosis at a personal level can still be a considerable shock and source of distress to the individual and family concerned. Suddenly a label is applied that seemingly sets them aside from others; that invokes dire consequences to both current well-being and to future health.
Such initial fears and misgivings may result from misunderstandings and ignorant, albeit well intentioned, advice from others. The misguided term “mild diabetes” may be used inappropriately to allay fears and anxieties, but in so doing it undermines the essential need to manage diabetes with due consideration and respect.
Recent published studies and clinical experience indicate that future prospects for people with diabetes should be very positive and encouraging, but despite the substantial improvements in treatments and technology, a demanding daily discipline is still required.
Realistic information and education needs to be very much geared to the individual, taking into account the very diversity of such individual needs and perspectives.
Necessary messages should be understood, but balancing the immediate influences on quality of life with longer term objectives on future health. Living with diabetes is a lifelong educational exercise and a similar experience for those involved in diabetes care. No amount of theoretical knowledge can match this constant learning through daily encounters with diabetes, but it is this experience that can be used to interpret and reassure. It is about achieving the right balance, and for this psychological awareness is essential.
Although the concept of a specific diabetes personality has been irrevocably refuted, diabetes will inevitably affect individuals emotionally in different ways. Both at diagnosis and in subsequent years a complex interaction between the physical consequences of diabetes and its psychological demands is constantly contributing to the vicissitudes of diabetes wellbeing. Even the term diabetes control carries psychological undertones, but it is the term we use most frequently.
Poor control may refer to inadequate achievement of good blood glucose levels, but it will also contribute to poor quality of life and often loss of personal confidence. It is the model of a vicious cycle. In contrast for others, particularly those with type 2 diabetes, the “silent” nature of the condition can be deceptive and deflect away from the need to maintain discipline and diligence.
Steering the narrow gap between Scylla and Charybdis is never easy, but there are now many new aids to assist the person with diabetes along the right pathway. No longer are treatments so rigid and set in tablets of stone; improved education and understanding do offer more flexibility adapted to the individual’s needs.
The person with diabetes should equally contribute to discussions and decisions concerning care and best treatment, fully informed and in collaboration with the clinician. Understanding the psychosocial issues of this partnership is fundamental to success. The expert and well-respected contributors to this book offer a valuable and necessary insight into the interaction between psychology and diabetes care, and in so doing provide guidance on psychological interventions to further minimise the daily demands of living with diabetes.