Psychosocial Care for People With Diabetes: A Position Statement of the American Diabetes Association

Complex environmental, social, behavioral, and emotional factors, known as psychosocial factors, influence living with diabetes, both type 1 and type 2, and achieving satisfactory medical outcomes and psychological well-being.Thus, individuals with diabetes and their families are challenged with complex, multifaceted issues when integrating diabetes care into daily life.To promote optimal medical outcomes and psychological well-being, patient-centered care is essential, defined as "providing care that is respectful of and responsive to individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions" (1).Practicing personalized, patient-centered psychosocial care requires that communications and interactions, problem identification, psychosocial screening, diagnostic evaluation, and intervention services take into account the context of the person with diabetes (PWD) and the values and preferences of the PWD.This article provides diabetes care providers with evidence-based guidelines for psychosocial assessment and care of PWD and their families.Recommendations are based on commonly used clinical models, expert consensus, and tested interventions, taking into account available resources, practice patterns, and practitioner burden.Consideration of life span and disease course factors (Fig. 1) is critical in the psychosocial care of PWD.This Position Statement focuses on the most common psychological factors affecting PWD, including diabetes distress and psychological comorbidities, while also considering the needs of special populations and the context of care. GENERAL CONSIDERATIONS IN PSYCHOSOCIAL CARERecommendations c Psychosocial care should be integrated with collaborative, patient-centered medical care and provided to all people with diabetes, with the goals of optimizing health outcomes and health-related quality of life.A c Providers should consider an assessment of symptoms of diabetes distress, depression, anxiety, and disordered eating and of cognitive capacities using patient-appropriate standardized/validated tools at the initial visit, at periodic intervals, and when there is a change in disease, treatment, or life circumstance.Including caregivers and family members in this assessment is recommended.B c Consider monitoring patient performance of self-management behaviors as well as psychosocial factors impacting the person's self-management.E c Consider assessment of life circumstances that can affect physical and psychological health outcomes and their incorporation into intervention strategies.E c Addressing psychosocial problems upon identification is recommended.If an intervention cannot be initiated during the visit when the problem is identified, a follow-up visit or referral to a qualified behavioral health care provider may be scheduled during that visit.E Practitioners should identify behavioral/mental health providers, ideally those who are knowledgeable about diabetes treatment and the psychosocial aspects of diabetes, with whom they can form alliances and use for referrals (Table 1) in the psychosocial care of PWD.Ideally, psychosocial care providers should be embedded in diabetes care settings.Shared resources such as electronic health records, management data, and patient-reported