Psychological Aspects of Diabetes Management

Diabetes mellitus is a largely self-managed disease. If the patient
is unwilling or unable to self-manage his or her diabetes
on a day-to-day basis, the outcome will be poor, regardless
of how advanced the treatment technology is. As Glasgow
et al. recently noted: ‘Diabetes is at heart a behavioural issue’.
Psychological and social factors have a vital role in diabetes
management.

Coping with diabetes

Treatment of diabetes is complex and demanding, and has
a major impact on the psychosocial functioning of patients
and their family, yet most patients, both children and adults,
seem to cope reasonably well with the strains of the disease.
The diagnosis of diabetes may come as a shock, and can
induce serious emotional distress in both patient and family.
Research indicates that emotional equilibrium is restored
within several months to 1 year after diagnosis in most patients,
and that they learn to integrate diabetes into their
daily lives. The onset of diabetes-related complications can be
significantly delayed by maintaining strict glycaemic control,
but many patients develop them at some time. Complications
such as eyesight problems or amputation can induce profound
psychological reactions, ranging from anger and guilt to
apathy and depression. At this stage, patients may be inclined
to stop their self-care activities.
Patients with diabetes need to come to terms with the fact
that they have a chronic disease and must ‘learn to live with
it’. However, to prevent diabetes-related complications, active,
problem-focused coping behaviour is required – patients
must take responsibility for daily management of the disease,
in different situations and over a long period of time.
Performing self-care tasks (particularly daily self-injections
of insulin and finger-pricks) and always having to think about
what can or cannot be eaten are generally found burdensome.
Adherence to the treatment regimen is complicated
by the fact that it often does not ‘pay off’ – that is, patients
receive little or no positive feedback in the short term to
help reinforce their daily efforts. This can be demotivating,
particularly in younger patients, who are more concerned
with the ‘here and now’ than the distant future. Also, ‘good’
behaviour does not always translate into good results, and
this is a major cause of frustration that can ultimately lead to
‘diabetes burnout’ (see below). It is not surprising that many
patients find it difficult to adhere to the treatment regimen
all the time. Even in the Diabetes Control and Complications
Trial, in which patients were self-selected and highly motivated,
less than one-half reached the target HbA1c level, and
only 5% maintained that level of control throughout the study.