More than Numbers: Dr. Mary de Groot on Diabetes Psychosocial Care

Living with diabetes can be challenging. Stress, burnout, embarrassment, hopelessness, depression and other psychosocial factors affect diabetes, in addition to our ability to manage it. The American Diabetes Association (ADA) has long recognized there are psychosocial aspects to living with diabetes. Finally, in December 2016, the ADA issued its first comprehensive and specific standards for psychosocial care. The article delves into the latest diabetes research, mental health recommendations, and expertise in the field. The authors are coming from the National Institutes of Health (NIH), Johns Hopkins University, Stanford University, and other reputable institutions. One of these authors is Dr. Mary de Groot, Associate Professor of Medicine and Psychology at Indiana University. Not only is she a licensed clinical psychologist, but she also has over 20 years of diabetes research and clinical experience. She's led diabetes professional organizations and been on the editorial board of scientific journals. Funded by the NIH, her research examines the link between diabetes and depression, as well as how to treat depression in adults and diverse populations with diabetes.

Tell me about the new ADA position statement on psychosocial care for people with diabetes?

This is the first comprehensive statement put forth by the ADA on the topic of psychosocial care of people with diabetes. It reflects over 40 years of psychosocial behavioral research and state-of-the-art clinical practice.
I'm honored to be a part of the writing team. Much credit goes to Dr. Deborah Young-Hyman, as well as all the others involved in our writing team and the ADA staff. Our writing team represents expertise in type 1 diabetes, type 2 diabetes, pediatric care, adults... We are all delighted this Position Statement is now available to the diabetes community.

What are some takeaways from the position statement?

First, successful management of diabetes extends beyond blood sugars and A1c numbers. While our numbers tell us how well our medical and lifestyle treatments are working, we are more than just our numbers. And, we know the behavioral demands of a self-management regimen are burdensome, but necessary, to reach treatment outcomes. We need to treat the behavioral and emotional needs of people with diabetes alongside their medical needs. Doing so has a synergistic effect — improve patient engagement in care, health outcomes, and overall well-being, and, in doing so, make it more likely that patients/families can carry out what patients and providers agree must be done to achieve better health.
Secondly, diabetes can go hand-in-hand with an increased risk for some mental health conditions — diabetes distress, depression, disrupted eating, and anxiety. These conditions not only impact quality of life and relationships for people with diabetes, but they also affect diabetes outcomes. This is a link people aren't always aware of. It's important to know there are successful ways of treating these conditions in people with diabetes just as there are in the general population.
Finally, there are many ways to deliver and receive psychosocial care. One size does not fit all! For patients, care should be tailored. It should be flexible, dynamic and change to meet the needs of people and their families over time. And, the models of healthcare delivery are not a one-size-fits-all proposition either. There are a lot of different ways providers can incorporate this care if they're not already doing so. There are ways providers can maximize the care they already provide by leveraging other resources and partners -- mental health providers, diabetes educators, community partners -- to extend their reach, so patient receive what they need when they need it.
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Chandra Y. Osborn, PhD, MPH
Jan 06, 2017

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