Clinicians should integrate psychosocial components into diabetes care, ADA recommends

Routine monitoring and screening for psychosocial issues and barriers to care are “clearly indicated” in patients with diabetes, according to a recent position statement by the American Diabetes Association (ADA).

Some of the evidence-based recommendations, published online on Nov. 22 by Diabetes Care, are summarized below.

General recommendations

• Clinicians should integrate psychosocial care into collaborative, patient-centered medical care for all patients with diabetes. (A-grade recommendation)
• Using validated tools, consider assessing cognitive capacities and symptoms of diabetes distress, depression, anxiety, and disordered eating at the initial visit, at periodic intervals, and whenever there is a medical- or life-related change. The ADA recommends including caregivers and family members in this assessment. (B)
• Consider monitoring patient performance of self-management behaviors, as well as psychosocial factors impacting self-management. (E)
• Consider assessing life circumstances that can affect physical and psychological health outcomes and incorporating them into interventions. (E)
• The ADA recommends addressing psychosocial problems when they are identified. If an intervention cannot be initiated during the same visit, a follow-up visit or referral to a qualified behavioral health clinician may be scheduled. (E)

Recommendations for specific patient populations

Adults:

• When caring for adults with childbearing potential, discuss life choices that could be impacted by diabetes self-management (e.g., pregnancy, sexual functioning). (B)
• Consider determining the presence of social support providers (e.g., family, peer support, lay diabetes educators) who may facilitate patients' self-management behaviors, reduce burden of illness, and improve quality of life. (B)

Older adults:

• Clinicians should annually screen adults ages 65 and older for early detection of mild cognitive impairment or dementia. (B)
• When treating older adults with diabetes and comorbid depression in the primary care setting, utilize a collaborative care model that incorporates structured nurse care management intervention. (A)
• The ADA recommends using available standards for conducting evaluations of dementia and age-related cognitive changes when assessing neuropsychological function and dementia. (E)

Patients with diabetes complications or functional limitations:

• Consider routinely monitoring for chronic pain associated with diabetes complications and its impact on quality of life. Provide appropriate pain management interventions, including referral to a behavioral health clinician for pain management strategies. (B)

In the context of bariatric surgery:

• Patients presenting for bariatric surgery should receive a comprehensive mental health assessment by a professional familiar with weight-loss interventions and postbariatric surgery behavioral requirements. (B)
• Consider postponing surgery if psychopathology is evident, particularly suicidal ideation and/or significant depression, so that patient suffering can be addressed before adding the burdens of recovery and lifestyle adjustment. (E)
• Consider postoperative assessment for need of ongoing mental health services to help patients adjust to medical and psychosocial changes. (C)