Psychosocial Aspects of Diabetes: The Diabetologists' Perspective

Diabetes mellitus is a multisystem disorder characterized by abnormalities in glucose, fat, and protein metabolism. The long-term microvascular complications of diabetes such as retinopathy, nephropathy, and neuropathy are the same in both forms of the disease. In both types of the disease, diabetes education, frequent monitoring of blood glucose, and regular screening to detect and treat complications at an early stage are an integral part of diabetes management. Patients have to emotionally accept the diagnosis of diabetes and also face the fact that they may already have potentially debilitating complications. Lack of compliance by patients may be a sign of frustration; it signals that goals of treatment and the approach to therapy should be reevaluated. This evaluation should include attention to possible social and psychological issues that may not be immediately apparent. These issues include fear of diabetes and its complications, stress with family or in the workplace and underlying psychiatric conditions. Conversely, both hyperglycemia and hypoglycemia can be very stressful. The relationship between stress and blood glucose control is further complicated by the fact that patients under psychological stress often change their behavior in ways that impact on glucose control. Despite the tremendous progress already made in our understanding of pathophysiology of diabetes and treatment of hyperglycemia, one thing remains unchanged. Life with diabetes continues to be a significant effort and often an overwhelming burden. The disease is complicated, treatments can be complex and prescriptions for patient regimens are often confusing. Diabetes treatment is dependent to a large extent on the individual's ability to practice adequate daily self care, a skill that requires critical support by the health care team. A multidisciplinary approach that includes professionals experienced in psychosocial problems is invaluable in helping these patients.