Diabetes distress: recognising the burden and addressing it in a targeted way

What it means

Diabetes distress is the emotional burden of living with diabetes and its daily treatment: worry, guilt, frustration, exhaustion. On its own it is not a mental illness in its own right, and it is not the same as depression. The two can occur at the same time, however. People who are highly distressed develop depression more often [1].

How common it is

In Norway, 21.7 % of more than ten thousand adults with type 1 diabetes reported a high level of distress [3]. In type 2 diabetes, a meta-analysis of 55 studies found 36 % [2]. How common it is also depends on how the burden is assessed, and in whom [1, 3].

What can help

Psychological interventions can reduce the burden related to diabetes. In type 2 diabetes, education can help as well. It is not yet sufficiently clear how strong the effect of this support is, or how long it lasts. A systematic review of 248 randomised studies found small to moderate effects for psychological interventions compared with usual care, with low to very low certainty of evidence [5].

In the German DIAMOS study, a behavioural therapy group programme reduced distress and depressive symptoms more than diabetes education, in people with subclinical depressive symptoms [4].

In type 1 diabetes, continuous glucose monitoring can reduce the burden a little compared with measurements on the finger. The EASD issues a conditional recommendation for this, with moderate certainty of evidence. Alarms and the volume of information can be a burden, but according to the EASD they probably do not outweigh the benefit [1].

Raising it and assessing it

The EASD recommends raising the emotional side at every consultation, assessing the burden at least once a year with a validated questionnaire, and also asking at important life events and at larger changes in treatment. These intervals are based on good clinical practice and are not supported by randomised studies. The results should be discussed, and the next steps decided together [1].

The German Diabetes Association (Deutsche Diabetes Gesellschaft) recommends yearly screening for depression with its own questionnaires, such as the PHQ-9, and names the PAID questionnaire when there are signs of distress related to diabetes [6].

Limits

The EASD judges the evidence for most measures to be of low certainty, and high-quality studies are scarce [1]. People who feel exhausted by diabetes should still raise it.

Note: If you have thoughts of suicide, seek professional help. If you are in immediate danger of harming yourself, contact the local emergency number at once or go to an emergency department.