Diabetes distress is a term used to describe the sense of frustration, anger and disillusionment that can lead to a reduction in a person’s ability to manage the condition over time and this neglect can have serious implications for the person’s health.
Although diabetes distress is very common, it is often not recognised by Diabetes Nurse Specialists (DNSs) or GPs for a number of reasons. Firstly, there is not enough time in an appointment to ask a patient how they are feeling or if they are coping; secondly, many DNSs have said that they feel ill-equipped to cope with the response.
Coming to terms with the implications of life with diabetes takes a considerable adjustment; symbolically it can be equated to being given care of a baby that is never going to grow up. However, there is little psychological support available for adults newly diagnosed with this condition.
If low mood and depression are detected some are referred to the Improving Access to Psychological Therapy programme, but as the therapists are not medically trained they cannot integrate the psychological care with the diabetes care. So there are few places for DNS to signpost patients for psychological support.
To address this PsychologyOnline has secured Small Business Research Initiative for Healthcare (SBRI Healthcare) funding to see how its approach to cognitive behaviourial therapy (CBT) can be used to treat diabetes distress.
The collaborative project aims to improve glycaemic control and psychological wellbeing through integrated care. It is led by Ann Hayes, chairman of PsychologyOnline, alongside Professor Khalida Ismail, who leads the Diabetes and Mental Health clinical service at King's College Hospital and Bruce Hellman, founder of uMotif, a health and wellbeing app.
Previous research at KCH has shown that specially trained DNSs delivering face-to-face CBT can help patients improve their blood glucose management. So Prof Ismail, a specialist in liaison psychiatry, is very interested in the potential for online CBT.
She says that around a third of patients have psychological issues interfering with their confidence to manage their diabetes: “Living with diabetes requires lifelong skills in calculating insulin doses and carbohydrate portions, taking into account physical activity. It is therefore understandable that some people may need psychological support from time to time to help them build their confidence towards effective blood glucose control.
“On the other hand, people with diabetes also have busy lives so trying to find the time and money to travel and attend face-to-face therapy sessions on top of the diabetes appointments is not always possible.
“I am very interested to investigate how online CBT integrated into usual diabetes care delivered by a specialist nurse can be used to provide an effective intervention.”
Online CBT is very effective at treating anxiety conditions such as those developed during diabetes distress and PsychologyOnline’s Thinkwell service is available without a GP referral.
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