The ability and motivation of patients to learn about their disease and to assume an active role in its treatment is closely related to their particular health beliefs, their personality, their psychosocial situation and their ability to cope with and actively accept their disease. Poorer outcomes are associated with poorer self management.
Those with diabetes are at greater risk of developing psychological problems and social factors play a vital role in its management. The prevention or delay of the long term complications require this self management. The onset of the chronic complications (eg eyesight loss; loss of limb) can produce psychological reactions (eg anger; guilt).
The diagnosis of diabetes can often come as a shock maybe serious emotional stress (both in the individual and family). ‘Emotional equilibrium’ is only restored after they have learnt to integrate the self management of the diabetes into their daily lives and routines. Personality characteristics play a role in mediating the effects.
Quality of life:
Quality of life of those with diabetes is significant impaired relative to those without diabetes , and is influenced by the number and types of complications. The management of diabetes has important impacts on psychosocial functioning.
Impacts on the quality of life include :
the need to depend on others for assistance
public confusion between type 1 and 2
public misconceptions about dietary requirements, the misconception that diabetes is ‘catching’ or is ‘self inflicted’, for example, by eating too much sugar
deciding who to tell about having diabetes (eg family, friends, co-workers, employers)
feelings of loss of control and embarrassment associated with ‘hypos’, particularly when in social situations or in the workplace
having to inject insulin or self test blood glucose away from home
inflexible care requirements which interfere with work, sporting, or social activities such as having to eat at regular intervals
difficulties obtaining and renewing driver’s licence
‘out of pocket’ expenses for medications, supplies and equipment
discrimination if life and travel insurance and in the workplace
exclusion from certain sports and from employment in certain job categories. For example, people treated with insulin are precluded from scuba diving and maybe from driving public passenger vehicles
At time of diagnosis children and adolescents may have a temporary adjustment disorder with somatic complaints, social withdrawal, sleep disturbance, emotional disturbance, anxiety and depression. Up to a third of children after diagnosis may have symptoms sufficient for it to be called a psychiatric disorder.
Psychological stress can affect glycaemic control by increased output of counter-regulatory hormones or by disrupting self care routines (eg eating, blood glucose monitoring, insulin doses). Levels of anxiety have been associated with glycaemic levels.
Understanding that self management is complex
Active participation of patient in setting goals
Depression is common and often overlooked.
Not clear is eating disorders are more common in those with diabetes, but they can have a major impact on metabolic control if present.
Several studies have reported that around 30-40% of young women with diabetes manipulate insulin does to promote weight loss.
• may coincide with other severe psychosocial problems
• ‘brittle diabetes’ – frequent severe hypoglycaemic and hyperglycaemic episodes, that often require hospitalisations, severe non-compliance with treatment (especially insulin).
Diabetes is associated with changes in cognition, usually manifested as a mild impairment is some cognitive skills (eg memory, motor speed, eye-hand co-ordination, visuospatial ability, measures of intelligence)
Stress & hassles:
High levels of stress are associated with poorer glycaemic control
Stress may glycaemic control by:
triggering a physiological increased output of counter-regulatory hormones
disrupting self care routines
Poor family functioning may affect glycaemic control
Emotional well being of other family members may be affected.
If diabetes is well controlled it should not be an issue – concern is the possibility of sudden hypoglycaemia in those on insulin. Driving skills deteriorate when blood glucose levels fall to 2.6. Different countries will have different restrictions.
Long distance driving is best avoided
The risk of hypoglycaemic may limit employment in some occupations.
eg in UK, use of insulin preclude employment in armed forces;
Shift work may pose problems for those with diabetes