Psychological care, counselling and diabetes. Part 2: Medical perspective

Future advances in the management of people with diabetes are becoming increasingly unlikely to take the form of new insulin preparations, delivery devices or drugs. The responsibility for diabetes management is increasingly being given back to patients themselves. Improvements in the management of diabetes may be more likely to come from an appreciation of how psychological well-being can have a major effect on an individual's ability to manage their diabetes. In this article I have described some examples where an awareness of these problems may allow for planning of their appropriate management. The ideal plan of action would be for the 'Diabetic Team' to meet with a psychologist in order to identify the needs of their clinic population. Plans can then be made for meeting those needs. Individuals can be identified for training in the appropriate skills. Counselling courses are widely available and some with diabetes particularly in mind already exist. Resources and time can then be set aside specifically for implementation of this care. Individual local resources and enthusiasm would decide what form this should take and whom, if anyone, from the 'Diabetes Team' should undergo training. There is already an awareness that Diabetes Nurse Specialists may require counselling skills and the opportunity to use these skills, and some 'Diabetes Teams' currently have a psychologist as a member. Overall, the most important change may be the recognition that specialist psychological advice and, hopefully, collaboration is required to provide a satisfactory standard of health care.