Department of Family Medicine (Drs. Beverly and Fredricks) and Department of Medicine (Mr. Ivanov and Ms. Court), Ohio University Heritage College of Osteopathic Medicine, Athens beverle1@ohio.edu
The authors reported no potential conflict of interest relevant to this article.
Diabetes distress, which affects almost half of those with diabetes, contributes to worsening glycemic control. Recognizing and responding to it is essential.
Managing diabetes is a complex undertaking, with an extensive regimen of self-care—including regular exercise, meal planning, blood glucose monitoring, medication scheduling, and multiple visits—that is critically linked to glycemic control and the prevention of complications. Incorporating all of these elements into daily life can be daunting.1-3
In fact, nearly half of US adults with diabetes fail to meet the recommended targets.4 This leads to frustration, which often manifests in psychosocial problems that further hamper efforts to manage the disease.5-10 The most notable is a psychosocial disorder known as diabetes distress, which affects close to 45% of those with diabetes.11,12
It is important to note that diabetes distress is not a psychiatric disorder;13 rather, it is a broad affective reaction to the stress of living with this chronic and complex disease.14,15 By negatively affecting adherence to a self-care regimen, diabetes distress contributes to worsening glycemic control and increasing morbidity.16-18
Recognizing that about 80% of those with diabetes are treated in primary care settings,19 we wrote this review to call your attention to diabetes distress, alert you to brief screening tools that can easily be incorporated into clinic visits, and offer guidance in matching proposed interventions to the aspects of diabetes self-management that cause patients the greatest distress.
Diabetes distress: What it is, what it’s not
For patients with type 2 diabetes, diabetes distress centers around 4 main issues:
frustration with the demands of self-care;
apprehension about the future and the possibility of developing serious complications;
concern about both the quality and the cost of required medical care; and
perceived lack of support from family and/or friends.11,12,20
As mentioned earlier, diabetes distress is not a psychiatric condition and should not be confused with major depressive disorder (MDD). Here’s help in telling the difference.
Unlike major depressive disorder, diabetes distress has a specific cause—diabetes—and can best be understood as an emotional response to a demanding health condition.
For starters, a diagnosis of depression is symptom-based.13 MDD requires the presence of at least 5 of the 9 symptoms defined by the Diagnostic and Statistical Manual of Mental Disorders, Fifth ed. (DSM-5)—eg, persistent feelings of worthlessness or guilt, sleep disturbances, lack of interest in normal activities—for at least 2 weeks.21 What’s more, the diagnostic criteria for MDD do not specify a cause or disease process. Nor do they distinguish between a pathological response and an expected reaction to a stressful life event.22 Further, depression measures reflect symptoms (eg, hyperglycemia), as well as stressful experiences resulting from diabetes self-care, which may contribute to the high rate of false positives or incorrect diagnoses of MDD and missed diagnoses of diabetes distress.23