Association of Diabetes Care & Education Specialists

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Practice Resources

Behavioral Health & Diabetes

Resources and guidance to support the behavioral health of individuals
with diabetes

Mental Health and Diabetes

Diabetes care and education specialists have a complementary role to play in the behavioral health of those with and affected by diabetes. This includes care and education that addresses the impact of emotions on health and well-being outcomes, including activation for diabetes self-management or prevention behaviors.

This area is now recognized as a critical component of any diabetes care plan, because if issues go unrecognized and untreated, care can become undermined and diabetes management impeded. You are perfectly positioned to notice when an individual is experiencing distress and can serve as a connector to mental health professionals. 

Take a look at the resources we've compiled. All of these will help to support your role as a connector and position you to provide holistic care to those you serve. 


Practice Paper

A Practical Approach to Mental Health for the Diabetes Care and Education Specialist

In 2017, the American Diabetes Association added mental health to its Standards of Medical Care in Diabetes, elevating its importance in overall diabetes care and making it critical that diabetes educators understand how to address mental health issues within their practice.

This new ADCES practice paper covers the different psychosocial concerns and potential pharmacologic options for people with diabetes. It also provides guidance on the screening and referral process.

Key Points:

  1. Depression and other mental health related conditions are more commonly found in people with diabetes. That’s the bad news. The good news is that there’s help! Diabetes care and education specialists need to help their patients overcome any stigma associated with mental illness and encourage them to seek treatment by a mental health professional, if needed.
  2. If a person with diabetes realizes that they are eating even when they are not hungry, this is a cue to the diabetes care and education specialists to help them make adjustments in their routine.
  3. If a person with diabetes has tried making behavioral changes and is struggling, be open to discussing current effective treatment through pharmacotherapy.
  4. Promote the role of caregivers who can serve as needed champions, helping the person with diabetes remember to do such things as take their medication as prescribed and manage stress.



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Download and print this infographic 

Sources

​1. Center for Behavioral Health Statistics and Quality. (2016). Key substance use and mental health indicators in the United States: Results from the 2015 National Survey on Drug Use and Health (HHS Publication No. SMA 16-4984, NSDUH Series H-51). Available at: http://www.samhsa.gov/data/. Accessed 29 May 2018.
2. Anderson, R. J., Freedland, K. E., Clouse, R. E., & Lustman, P. J. (2001). The prevalence of comorbid depression in adults with diabetes: A meta-analysis. Diabetes Care, 24, 1069 –1078.
3. Young-Hyman D, de Groot M, Hill-Briggs F, et al. Psychosocial Care for People with Diabetes: A Position Statement of the American Diabetes Association. Diabetes Care 2016; 39: 2126–2140.
4. Grigsby AB, Anderson RJ, Freedland KE, et al. Prevalence of anxiety in adults with diabetes: A systematic review. Journal of Psychosomatic Research 2002;53: 1053–1060
5. Matlock, Jones, Corathers, et al. Clinical and psychosocial factors associated with suicidal ideation in adolescents with type 1 diabetes. J Adolesc Health 2017;61(4):471-477.
6. Van Buren DJ, Wilfley DE, et al. Depressive symptoms and glycemic control in youth with type 2 diabetes participating in the TODAY clinical trial. Diabetes Res Clin Pract 2018;135:85-87.
7. Young V, Eiser C, Johnson B, et al. Eating problems in adolescents with T1D: A systematic review with meta-analysis. Diabetic Medicine 2013;30:189–198.
8. Young-Hyman, D. (2012). Eating disorders and disordered eating behavior. In D. Young-Hyman & M. Peyrot (Eds.), Psychosocial care. Washington,DC: American Diabetes Association.






Downloadable Resources for People with Diabetes

When someone is diagnosed with diabetes, a variety of emotions can emerge including sadness, guilt, fear, anger and others. There is no way to predict the emotions that will develop upon diagnosis, but there are ways to manage them.

Anger

Anger and Diabetes

Also available in Spanish/Español

Stress

Stress and Diabetes

Also available in Spanish/Español

Depression

Depression and Diabetes

Also available in Spanish/Español

Distress

Distress and Diabetes

Also available in Spanish/Español



Healthy Coping

AADE7_healthy_coping_Page_1

Also available in Spanish/Español







Type 1 Diabetes Resources For Your Practice

Diabetes Distress

DiabetesDistress_Page_1

 

Diabetes Resilience

Resiliencein Diabetes_Page_1

 

Family Conflict 

Ebrief_2_Family Conflict_Page_1

 







Education to Enhance Your Practice

Recorded Webinars

AADE's [ADCES'] Practical Approach to Mental Health for the Diabetes Specialist
Reviews the ADCES practice paper, A Practical Approach to Mental Health for the Diabetes Educator, and describes common psychosocial considerations in people with diabetes (e.g. depression, anxiety, diabetes distress, disordered eating, etc.), the pharmacological impact of relevant medications, appropriate assessment and referral strategies, and effective communication practices. 60 minutes, 1 CE 

Mental Illness and Diabetes in Vulnerable Populations: Developing a Diabetes Champion Program
Research shows that 8 to 17 % of people with serious mental illness also have diabetes. This presentation will discuss how a diabetes champion program was created to address the prevalence of diabetes in people with serious mental illness, educate and empower staff to become diabetes resources, and create a position for a full-time diabetes specialist to address the needs of these individuals. 60 minutes, 1 CE

No one understands me! Helping People Live Well With Diabetes
Only 32% of people with diabetes reported recently being asked about their emotional well-being by a member of their health care team. This interactive session will discuss new evidence about the negative effects of diabetes-related distress. It will explore effective and practical strategies diabetes specialists can incorporate into care delivery models to address emotional well being. 60 minutes, 1 CE

Shame and Diabetes: Practicing Resilience in a Culture of Weight Stigma, Disordered Eating and Healthism
Nearly 3/4 of people with type 2 diabetes report feeling shame about having diabetes, and shame-based self-talk and behaviors have been correlated with all types of diabetes. Presenters will define shame and how it is exacerbated in a culture of weight stigma and healthism, which can lead to disordered eating and other barriers to diabetes management. 60 minutes, 1 CE

Why a Patient Story Matters: Addressing Psychosocial Needs During Diabetes Education
Designed to address the psychosocial components that often feel like “unchartered waters” for diabetes care and education specialists, participants will be able to address psychosocial components and utilize behavior change theories and techniques to improve services for people with diabetes. 90 minutes,     1.5 CE

Helping Individuals Deal with Diabetes Stigma and Guilt
Diabetes care and education specialists can play a critical role in shifting the “shame and blame” paradigm. Participants will learn the extent of the problem and new strategies for helping people with diabetes move away from diabetes stigma (judgement, shame, discouragement, avoidance) and gain tools for empowerment, encouragement and engagement. 60 minutes, 1 CE

“Please Don’t Cry!” Effective Ways to Handle Emotions (Yours and Your Patients’)
As a diabetes care and education specialist, you have probably had patients become very emotional and challenge your care giving ability or expertise. Participants will explore strategies that can help you accomplish more with patients who feel anxiety, denial, depression, anger, hopelessness and more. 60 minutes, 1 CE

    A Practical Approach to Mental Health for People with Diabetes
    Jasmine Gonzalvo, BCPS, BC-ADM, CDE, LDE, FAADE, and Jay Hamm, PsyD, HSPP talk about the link between diabetes and mental health, describe how medications and their pharmacologic effects can affect diabetes management and understanding when to refer people to mental health services and how to recognize an emergency situation. 
    Offered by the AMGA Foundation through its Together 2 Goal National Diabetes Campaign


    Publications

    Diabulimia What It Is and How To Treat It


    Diabulimia—Diabetes & Eating Disorders: What It Is and How to Treat It

    Learn how to identify individuals at high-risk for diabulimia. Recognize and circumvent the strategies individuals with diabetes use to avoid weight gain.

    Psychosocial Care for People with Diabetes


    Psychosocial Care for People with Diabetes 

    This book covers all the issues that care providers should consider when a person with diabetes takes on the challenges of diabetes self-management and manages living with a chronic disease. Sections cover behavior health, self-management, implementation of treatment technology and life course issues.

    This landmark text covers all of the issues that care providers should consider when a patient takes on the burdens of diabetes self-management and deals with living with a chronic disease. Sections cover behavioral health, self-management, implementation of treatment technology, and life course issues.







    ADCES Journal Articles


    The Diabetes Educator

    Effectiveness of Diabetes Self-Management Education Programs for US Latinos at Improving Emotional Distress: A Systematic Review
    Vol 45, 1. First Published December 20, 2018
    Angela P. Gutierrez, MS; Addie L. Fortmann, PhD; Kimberly Savin, BA; Taylor L. Clark, BS; Linda C. Gallo, PhD

    Diabetes Distress Among Persons with Type 1 Diabetes: Associations with Disordered Eating, Depression and Other Psychological Health Concerns
    Vol 43, 1: pp. 83-93. First Published December 7, 2016
    Margaret A. Powers, PhD, RD; Sara A. Richter, MS; Diann M. Ackard, PhD; Cheryl Craft, RN

    Understanding Diabetes-Related Distress Characteristics and Psychosocial Support Preferences of Urban African American Adults Living With Type 2 Diabetes: A Mixed-Methods Study
    Vol. 44, 2: pp. 144-157. First Published January 27, 2018
    Sula Hood, PhD; Amy Irby-Shasanmi, PhD; Mary de Groot, PhD; Elissabeth Martin, BA; Andrew S. LaJoie, PhD

    The Diabetes Educator Journal

    ADCES in Practice

    Mental Health in People with Diabetes: A Needs Assessment for the Diabetes Care and Education Specialist
    Jasmine D. Gonzalvo, PharmD, BCPS, BC-ADM, CDE, LDE, Mary de Groot, PhD, HSPP, Joanne Rinker, MS, RD, CDE, LDN, FAADE, Andrea R. Hilligoss, PharmD Candidate, Athena L. Vu, PharmD Candidate
    First Published: August 16, 2018

    Are We Addressing Our Patients’ Mental Health?
    Teresa Pearson, MS, RN, CDE, FAADE
    First Published: June 20, 2014

    When Will It Be Okay to Talk About Mental Illness? 
    Teresa Pearson, MS, RN, CDE, FAADE
    First Published: August 16, 2016

    When It All Gets to Be Too Much: Addressing Diabetes Distress in African Americans 
    Adeola Akindana, APRN, DNP, CDE; Michelle Owens-Gary, PhD, MA; Alexis Williams, MPH, MS, CDE
    First Published: June 31, 2016

    Depression, Diabetes Distress and Diabetes Self-Management: Progress and Persistence
    Joseph Nelson, MA, LP, CST
    First Published: August 19, 2013

    Stress Management
    Janis Roszler, LMFT, RD, LD/N, CDE, FAND; Melissa Brail, LMFT
    First Published: April 26, 2017

    AADE in Practice Cover





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