VOLUME 11 NUMBER 3 • SEPTEMBER 2014
135
SA JOURNAL OF DIABETES & VASCULAR DISEASE
PATIENT INFORMATION LEAFLET
well as type 2 diabetes in predisposed individuals.
32
Psychological distress
and poor glycaemic control have been linked in patients with established
type 1 and type 2 diabetes.
32,35
Stress elicits the release of counter-regu-
latory hormones, such as adrenaline and cortisol, which in turn results in
energy mobilisation, often resulting in elevated glucose levels. In addition,
stress can disrupt diabetes control by negatively affecting indispensable
self-care behaviours.
36
Fortunately stress-management techniques can
play a significant role in long-term glycaemic control.
32
Diabetic patients
can therefore benefit greatly from stress-management training.
37
Cognitive impairment
Diabetes is associated with a greater rate of decline in cognitive function
and a greater risk of cognitive decline.
38,39
Findings with regard to the
contribution of co-morbid depression and diabetes to the development of
cognitive impairment have been mixed. While one study showed no sig-
nificant relationship between depression and dementia,
39
another study
with a cohort of 3 837 diabetic patients found that patients with major
depression and diabetes had an increased risk of the development of
dementia compared to those with diabetes alone.
40
With regard to the aetiology of diabetes, cognitive deficits have been
associated with chronic hyperglycaemia and frequent, severe hypogly-
caemic episodes.
41
Cognitive deficits and decline will have a direct effect
on the patient’s ability to self-care. Family involvement becomes a crucial
part of diabetes care at this point. Screening and early detection are es-
sential to ensure that adherence is not adversely affected.
THE WAY FORWARD
The clinical significance of identifying and appropriately treating psycho-
logical problems in diabetic patients is well documented. Psychosocial
adaptation is an important treatment outcome as it positively influences
quality of life and treatment efficacy.
8
Given the adverse effect of the
presence of psychological conditions on diabetes management, a com-
prehensive approach to managing diabetes is required.
A multidisciplinary team comprising relevant medical and allied health
professionals would be ideal in order to tackle the physical and psycho-
logical complexities of diabetes.
42
In addition, a patient-centred collabo-
rative treatment approach that engages with and empowers the patient
to actively participate in his/her consultations and treatment and encour-
ages open communication between patient and provider is highly rec-
ommended as a means of enlisting adherence.
8
This open collaborative
communication should include discussions about barriers to adherence,
emotional responses to diabetes and psychological factors that affect
adherence and coping. Various authors have made a case for empower-
ing patients, simply because every aspect of diabetes management is
dependent on the patient choosing to adhere.
11,43
In cases where a multidisciplinary approach is not possible, effective
screening and appropriate referral becomes essential. The psychological
problems of depression, anxiety, eating-disordered behaviour and eating
disorders discussed in this article require comprehensive psychothera-
peutic and psychopharmacological intervention. Screening for cognitive
decline and involving the family in diabetes management is essential to
ensure glycaemic control despite cognitive deficits. Addressing these
psychological presentations and recognising the role of psychology in
diabetes management can significantly improve glycaemic control and
delay and/or prevent diabetes complications.
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