Psychological factors in intensive management of insulin-dependent diabetes mellitus

With the publication of the DCCT results in 1993, hope has been given to patients with type I diabetes that blindness, kidney failure, and neuropathies are not necessarily what awaits them. However, to assume that diabetes is simply a disease that can be controlled "if only the patient would be compliant" is an incredibly naive way to approach treatment. Practitioners need to be keenly aware of not only the complexities of intensive management of type I diabetes but perhaps more importantly the numerous psychological factors that determine whether treatment adherence will occur. Psychological issues such as patient perceptions of symptoms, fear, unawareness of symptoms because of autonomic dysregulation or cognitive decline, attitudes, and control issues need to be assessed. These issues can be assessed quite easily with questionnaires, scales, and interview schedules readily available to practitioners. Additionally, for those patients who may not be attuned to monitoring physiologic or cognitive cues, awareness training and other coping skills interventions are available that can be incorporated into existing diabetes education programs. A mutual effort by the patient and health-care provider team can lead to success in intensive management of IDDM.