New Initiative Targets Psychosocial Issues Related to Diabetes

The position statement advises clinicians to assess psychosocial and mental health issues using appropriate and validated tools at initial diabetes care visits and periodic intervals, or when there is a change in disease, treatment, or life circumstances.

Situations warranting referral to a mental health provider include ongoing difficulty with diabetes self-care after provision of diabetes education; a positive screen for symptoms of depression, anxiety, or cognitive impairment; or any suspicion of serious mental illness including eating disorders.

The document specifically addresses the entity “diabetes distress,” a common problem resulting from the numerous demands of self-managing diabetes such as medication dosing, glucose monitoring, adherence to diet recommendations, and physical activity.

Special situations, including patients who are taking antipsychotics and counseling for patients who are slated for bariatric surgery, are also addressed in the document.

While Vanderlip generally agreed with the referral criteria in the statement, he believes that “when possible, evidence-based integration of behavioral health services is far superior to traditional referral models for behavioral health care.”

APA is in the midst of a large, federally supported initiative to improve access to behavioral health services through collaborative care, he noted, and train psychiatrists and primary care physicians to work in the collaborative care model.

Indeed, the ADA has long advocated for that model, and the new statement re-endorses it. “Definitely a team-based approach with a mental health provider integrated into the clinic is very important,” Fogarty said, but added “with cost constraints, many clinics don’t have that, so next best thing is to have a provider for referral in the community.”

Regardless of the delivery model, there just aren’t enough mental health professionals with expertise in diabetes to achieve the integration goal, according to Fogarty. There is a small cadre of psychologists in the United States—numbering just about 50 to 100 individual providers—who specialize in the psychosocial issues associated with diabetes, she said. Building those ranks is the aim of the new educational pilot program that the ADA will launch later this year as pre-courses held in conjunction with the ADA’s and the American Psychological Association’s annual meetings.

The courses, which will provide continuing education credit, will span two days: one in-person session on diabetes basics, the other conducted online. After passing an exam, providers will qualify to be listed in a new ADA online Mental Health Provider referral directory. Psychiatrists are more than welcome to attend, Fogarty said. ■