[Psychological implications of diabetes mellitus]

Daily self-care is the cornerstone of diabetes management. Psychosocial factors play an important role in the self-management of patients with diabetes. Diabetes demands a lot of the patient and his or her relatives in terms of motivation and adaptation. Adaptation problems may occur in response to the diagnosis, but also when the patient is confronted with repeated hypoglycaemic episodes, or when switching to insulin treatment and when complications develop. Psychological comorbidities are prevalent among people with diabetes. In particular eating disorders, anxiety, depression and sexual problems warrant special attention. These problems are often associated with poorer diabetes control. Guidelines exist for psychological diagnosis and treatment in diabetes. Systematic monitoring of psychological well-being as part of routine diabetes care is advocated. Psychological support contributes to better management of diabetes, but this form of therapy is not sufficiently covered by diagnosis/treatment reimbursements in the Dutch health service system.