Type 1 Diabetes Through the Life Span: A Position Statement of the American Diabetes Association

Jane L. Chiang; M. Sue Kirkman; Lori M.B. Laffel; Anne L. Peters

Disclosures

Diabetes Care. 2014;37(7):2034-2054. 

In This Article

Psychosocial: Assessment and Treatment of Psychosocial Issues

Assessment and appropriate management of psychosocial issues are important throughout the life span of individuals with type 1 diabetes. In pediatrics, health care providers should assess the individual child and the child's family for their ability to function and behave appropriately regarding safe and responsible diabetes care. For adults, the individual is the focus of care. However, family involvement should be strongly encouraged when appropriate.

Depression screening and discussion about psychosocial issues are important components of the diabetes visit. Special attention should be paid to diabetes-related distress, fear of hypoglycemia (and hyperglycemia), eating disorders, insulin omission, subclinical depression, and clinical depression. These factors are significantly associated with poor diabetes self-management, a lower quality of life, and higher rates of diabetes complications. As individuals age, health care providers should evaluate issues related to self-care capacity, mobility, and autonomy. Such factors are to be promptly addressed, as they make the management of type 1 diabetes ever more problematic.

Recommendations.

  • Make age-appropriate screenings for psychosocial issues a component of most diabetes visits. Any concerns should be pursued through treatment that may include referral to a mental health specialist. (E)

Additional Considerations for Pediatrics

  • Ensure that there is developmentally appropriate parent/family involvement in the management of the child's/adolescent's diabetes care tasks, avoiding a premature transfer of sole responsibility for diabetes management to the developing child/teenager. (B)

  • Directly ask about diabetes-related family conflict and stress and negotiate an acceptable resolution with the child/adolescent and parent(s). However, if family conflict is extremely entrenched and cannot be resolved by the diabetes team, referral should be made to a mental health specialist who is knowledgeable about type 1 diabetes in youth and family functioning. (C)

Additional Considerations for Adults

  • Ongoing evaluation of patients' general and diabetes-related quality of life, emotional well-being, distress, depression, and resources is warranted, preferably by a team that includes a mental health specialist if such resources are available. (C)

  • Health care providers should promptly address issues related to self-care capacity, mobility, and autonomy. (E)

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