A Practical Approach to Mental Health for the Diabetes Educator

Gonzalvo, Jasmine D.; Hamm, Jay A.; Eaves, Shannon; Muñoz, Cynthia E.; Groot, Mary de; Hill‐Briggs, Felicia; Cypress, Marjorie; Streisand, Randi

doi:10.1177/2325160319826929

Cited by 26 publications

(18 citation statements)

References 106 publications

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“…It has a greater impact on behavioral and metabolic outcomes than does depression (66). Diabetes-related distress is responsive to intervention, including DSMES-focused interventions (68) and family support (49). However, additional mental health resources are generally required to address severe diabetes-related distress, clinical depression, and anxiety (65).…”

Section: When Complicating Factors Developmentioning

confidence: 99%

Diabetes Self-management Education and Support in Adults With Type 2 Diabetes: A Consensus Report of the American Diabetes Association, the Association of Diabetes Care & Education Specialists, the Academy of Nutrition and Dietetics, the American Academy of Family Physicians, the American Academy of PAs, the American Association of Nurse Practitioners, and the American Pharmacists Association

et al. 2020

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Diabetes is a complex and challenging disease that requires daily self-management decisions made by the person with diabetes. Diabetes self-management education and support (DSMES) addresses the comprehensive blend of clinical, educational, psychosocial, and behavioral aspects of care needed for daily self-management and provides the foundation to help all people with diabetes navigate their daily self-care with confidence and improved outcomes (1,2). The prevalence of diagnosed diabetes is projected to increase in the U.S. from 22.3 million (9.1% of the total population) in 2014, to 39.7 million (13%) in 2030, and to 60.6 million (17%) in 2060 (3). Approximately 90-95% of those with diabetes have type 2 diabetes (4). Diabetes is an expensive disease, and the medical costs of health care alone for a person with diabetes are 2.3 times more than for a person without diabetes (5). Confounding the diabetes epidemic and high costs, therapeutic targets are not being met (6). There is a lack of improvement in reaching clinical target goals since 2005 despite advancements in medication and technology treatment modalities. Indeed, between 2010 and 2016 improved outcomes stalled or reversed (6). The goals of this Consensus Report are to improve clinical care and education services, to improve the health of individuals and populations, and to reduce diabetesassociated per capita health care costs (1,7). This article is specifically directed toward health care providers (physicians, nurse practitioners, physician assistants [PAs]), referred to herein as providers, as it outlines the benefits of DSMES, defines four critical times to provide and modify DSMES (see Fig. 1), proposes how to locate DSMESrelated resources, and discusses potential solutions to access and utilization barriers. This

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Section: When Complicating Factors Developmentioning

confidence: 99%

Diabetes Self-management Education and Support in Adults With Type 2 Diabetes: A Consensus Report of the American Diabetes Association, the Association of Diabetes Care & Education Specialists, the Academy of Nutrition and Dietetics, the American Academy of Family Physicians, the American Academy of PAs, the American Association of Nurse Practitioners, and the American Pharmacists Association

et al. 2020

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“…Psychological and social problems can impair the individual's (11,(197)(198)(199)(200)(201) or family's (200) ability to carry out diabetes care tasks and therefore potentially compromise health status. There are opportunities for the clinician to routinely assess psychosocial status in a timely and efficient manner for referral to appropriate services (202,203). A systematic review and metaanalysis showed that psychosocial interventions modestly but significantly improved A1C (standardized mean difference -0.29%) and mental health outcomes (204).…”

Section: Diabetic Kidney Diseasementioning

confidence: 99%

5. Facilitating Behavior Change and Well-being to Improve Health Outcomes:Standards of Medical Care in Diabetes—2020

2019

Diabetes Care

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The American Diabetes Association (ADA) "Standards of Medical Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee (https://doi.org/10 .2337/dc20-SPPC), are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations, please refer to the Standards of Care Introduction (https://doi.org/10.2337/dc20-SINT). Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes .org/SOC. Effective behavior management and psychological well-being are foundational to achieving treatment goals for people with diabetes (1,2). Essential to achieving these goals are diabetes self-management education and support (DSMES), medical nutrition therapy (MNT), routine physical activity, smoking cessation counseling when needed, and psychosocial care. Following an initial comprehensive medical evaluation (see Section 4, "Comprehensive Medical Evaluation and Assessment of Comorbidities," https://doi.org/10.2337/dc20-S004), patients and providers are encouraged to engage in person-centered collaborative care (3-6), which is guided by shared decision-making in treatment regimen selection, facilitation of obtaining needed medical and psychosocial resources, and shared monitoring of agreed-upon regimen and lifestyle (7). Re-evaluation during routine care should include not only assessment of medical health but also behavioral and mental health outcomes, especially during times of deterioration in health and well-being. DIABETES SELF-MANAGEMENT EDUCATION AND SUPPORT Recommendations 5.1 In accordance with the national standards for diabetes self-management education and support, all people with diabetes should participate in diabetes self-management education and receive the support needed to facilitate the knowledge, decision-making, and skills mastery necessary for diabetes selfcare. A 5.2 There are four critical times to evaluate the need for diabetes selfmanagement education to promote skills acquisition in support of regimen Suggested citation: American Diabetes Association. 5. Facilitating behavior change and wellbeing to improve health outcomes:

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“…11 However, long-term maintenance of diabetes control is still an issue for some individuals even after DSME courses are completed. 12 Inequities found in the social determinants of health add to the struggles of diabetes management including low-income, 13 inadequate housing, 14 behavioral health needs, 15 and lack of health insurance. 16 In addition, lack of resources/support for medications and doctor visits, 17 transportation, 4 day labor jobs/choice between work and doctor visits, 18 culture and language capabilities 19 are other barriers to diabetes self-management found among Mexican American populations.…”

Section: Introductionmentioning

confidence: 99%

Improved diabetes control among low-income Mexican Americans through community-clinical interventions: results of an RCT

Reininger

Lee

Hessabi

et al. 2020

BMJ Open Diab Res Care

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IntroductionThis randomized controlled trial investigated community-clinical intervention strategies for a Mexican American population who had not demonstrated control of their diabetes. We tested a control program (Salud y Vida 1.0) supporting diabetes management versus an enhanced version (Salud y Vida 2.0) for reductions in HbA1c at 12 months.Research design and methodsAdults with uncontrolled diabetes (n=353) were enrolled if they had an HbA1c≥9.0% during a program or doctor’s visit between 6 and 36 months of their receipt of SyV 1.0 services, were patients at one of two clinics in local counties, and had an HbA1c≥8.0% at SyV 2.0 baseline enrollment. The control and intervention arms were coordinated by community health workers and the intervention arm included the control program enhanced with medication therapy management; behavioral health services; peer-led support groups; and additional community-based lifestyle programs also open to the family.ResultsAt 12 months, both study arms improved HbA1c (mean, (CI), Control (−0.47 (-0.74 to –0.20)) and intervention (−0.48 (-0.76 to –0.19)). The intervention group maintained HbA1c levels after month 6, whereas control group HbA1c levels slightly increased (adjusted mean from 9.83% at month 6%–9.90% at month 12). Also, HbA1c was examined by level of participant engagement. The high engagement group showed a decreasing trend over the study period, while control and lower engagement groups failed to maintain HbA1c levels at month 12.ConclusionsImproved HbA1c was found among a population that had not demonstrated diabetes management prior; however, mean HbA1c values were above clinical guideline recommendations. The randomized control trial findings provide additional evidence that extended time and intervention supports may be needed for populations experiencing inequities in social determinants of health.Trial registration numberNCT04035395.

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A Practical Approach to Mental Health for the Diabetes Educator

Cited by 26 publications

References 106 publications

5. Facilitating Behavior Change and Well-being to Improve Health Outcomes:Standards of Medical Care in Diabetes—2020

Improved diabetes control among low-income Mexican Americans through community-clinical interventions: results of an RCT

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