by Melanie Teslik, BC-ADM, CDE, MS, RN, 2019 Member Affilates Council
The new Standards of Medical Care in Diabetes, provided by ADA, discusses Goals of Care to prevent complications and optimize quality of care through a patient-centered communication style. Diabetes Care is managed through a multidisciplinary team that includes the primary physician, subspecialty physicians, nurse practitioners, physician assistants, nurses, dietitians, exercise specialists, pharmacists, dentists, podiatrists and mental health professionals. These are some of the many professions of AADE members.
As diabetes specialists, we address issues through lifestyle intervention, pharmacological intervention, prevention of cardiovascular disease and Diabetes Self-Management Education and Support. However, before we we can intervene we must address the psychosocial status of the client, where he or she is at cognitively, and what aspects of diabetes care the individual is able to implement.
We need to address clients' attitudes about diabetes and their emotional well-being. Is the client able and willing to make the changes to improve his/her quality of life? The client comes with social, environmental, behavioral, and emotional baggage. It is easy to address concrete issues but we need to spend time addressing the client's mental status before any significant changes can be made.
We should refer to psychologists or social workers as needed for definitive signs of mental health concerns. These may be everyday issues that we handle as providers, such as depression, anxiety, eating disorders, and cognitive struggles performing the tasks required to manage diabetes. Of primary concern is the distress associated with the burden of diabetes self-care. This includes monitoring blood glucose, taking medications, cost of care, physical activity and eating patterns. Additionally, the client has to worry about potential complications. As providers, we need to understand how to address these issues and motivate our clients to change, often in incremental stages. We need to identify where our clients are at in a particular moment in time and develop appropriate goals that they can obtain. Videos, resources and AADE's practice paper on the role of the diabetes educator in addressing psychosocial concerns for people with diabetes are available on AADE's Mental Health and Diabetes tools page.