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Cited by 1,072Diabetes Management and EducationDiabetes Management and ResearchCancer survivorship and care

Psychosocial care for people with diabetes: a position statement of the American Diabetes Association

Open access
Young-Hyman, Deborah, de Groot, Mary, Hill-Briggs, Felicia, Gonzalez, Jeffrey S., Hood, Korey, Peyrot, Mark·2016·Diabetes Care
DOI 10.2337/dc16-2053PMC PMC5127231
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Abstract

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.EPractitioners 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.

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Cites

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Claims the paper makes

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  • Findingcitation

    In one study of people with type 1 diabetes, sexual dysfunction was reported in up to 50% of male participants.

    “In one study of individuals with type 1 diabetes, sexual dysfunction was reported in as many as 50% of male patients (107).”
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    • cites [107] Hatzimouratidis, 2014, How to treat erectile dysfunction in men with diabetes: from pathophysiology to treatment, Curr Diab Rep source

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  • Findingcitation

    A meta-analysis found that people with diabetes have a 127% higher risk of vascular dementia than people without diabetes.

    “A meta-analysis of prospective and observational studies in PWD showed a 73% increased risk of all types of dementia, a 56% increased risk of Alzheimer dementia, and a 127% increased risk of vascular dementia compared with individuals without diabetes (115).”
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    • cites [115] Gudala, 2013, Diabetes mellitus and risk of dementia: a meta-analysis of prospective observational studies, J Diabetes Investig source

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  • Findingcitation

    A meta-analysis found that people with diabetes have a 73% higher risk of all types of dementia than people without diabetes.

    “A meta-analysis of prospective and observational studies in PWD showed a 73% increased risk of all types of dementia, a 56% increased risk of Alzheimer dementia, and a 127% increased risk of vascular dementia compared with individuals without diabetes (115).”
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    • cites [115] Gudala, 2013, Diabetes mellitus and risk of dementia: a meta-analysis of prospective observational studies, J Diabetes Investig source

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  • Findingcitation

    A meta-analysis found that people with diabetes have a 56% higher risk of Alzheimer dementia than people without diabetes.

    “A meta-analysis of prospective and observational studies in PWD showed a 73% increased risk of all types of dementia, a 56% increased risk of Alzheimer dementia, and a 127% increased risk of vascular dementia compared with individuals without diabetes (115).”
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    • cites [115] Gudala, 2013, Diabetes mellitus and risk of dementia: a meta-analysis of prospective observational studies, J Diabetes Investig source

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  • Premisecitation

    Care models that consider cultural influences and personal, family, and community resources and adapt care to the individual's values and lifestyle are more likely to succeed.

    “Care models that take into account cultural influences, as well as personal, family, and community resources, and tailor care to the core values and lifestyle of the individual are more likely to be successful (2).”
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    • cites [2] Kahn, 2009, Improving diabetes care: the model for health care reform, Diabetes Care source

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  • May combine two claims. 27
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    Premisecitation

    Anxiety symptoms and diagnosable anxiety disorders are common in people with diabetes.

    “Anxiety symptoms and diagnosable disorders (e.g., generalized anxiety disorder [GAD], body dysmorphic disorder, obsessive compulsive disorder [OCD], specific phobias, and posttraumatic stress disorder [PTSD]) are common in PWD (61);”
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    • cites [61] Smith, 2013, Association of diabetes with anxiety: a systematic review and meta-analysis, J Psychosom Res source

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    Premisecitation

    Consistent adherence to treatment regimens improves A1C, but the improvement is modest.

    “While following treatment regimens consistently improves A1C (9–12), the impact is modest.”
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    • cites [9] Asche, 2011, A review of diabetes treatment adherence and the association with clinical and economic outcomes, Clin Ther source

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    • cites [10] Hood, 2009, Association between adherence and glycemic control in pediatric type 1 diabetes: a meta-analysis, Pediatrics source

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    • cites [11] Schectman, 2002, The association between diabetes metabolic control and drug adherence in an indigent population, Diabetes Care source

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    • cites [12] Feldman, 2014, Defining the role of medication adherence in poor glycemic control among a general adult population with diabetes, PLoS One source

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    Premisecitation

    Diabetes distress, limited social and economic resources, other psychological conditions (depression, anxiety, eating disorders, cognitive impairment), health literacy, and numeracy affect self-care.

    “Thus, psychosocial factors impacting self-care such as diabetes distress (burdens of diabetes and its treatment, worries about adverse consequences), lack of social and economic resources, and other psychological states (e.g., depression, anxiety, eating disorders, cognitive impairment) (3), as well as health literacy and numeracy, should be monitored.”
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    • cites [3] Ducat, 2014, The mental health comorbidities of diabetes, JAMA source

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    Premisecitation

    Reported diabetes distress prevalence is 18-45%, with an 18-month incidence of 38-48%.

    “Its prevalence is reported to be 18–45% with an incidence of 38–48% over 18 months (41).”
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    • cites [41] Aikens, 2012, Prospective associations between emotional distress and poor outcomes in type 2 diabetes, Diabetes Care source

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    Premisecitation

    Fear of hypoglycemia and hypoglycemia unawareness often occur together, and treating one often helps the other.

    “FoH and hypoglycemia unawareness often co-occur, and interventions aimed at treating one often benefit both (69).”
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    • cites [69] Yeoh, 2015, Interventions that restore awareness of hypoglycemia in adults with type 1 diabetes: a systematic review and meta-analysis, Diabetes Care source

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    Premisecitation

    High diabetes distress significantly affects medication-taking and is associated with higher A1C, lower self-efficacy, and worse dietary and exercise behaviors.

    “High levels of diabetes distress significantly impact medication-taking behaviors and are linked to higher A1C, lower self-efficacy, and poorer dietary and exercise behaviors (39,41,42).”
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    • cites [39] Fisher, 2012, When is diabetes distress clinically meaningful?, Establishing cut points for the Diabetes Distress Scale. Diabetes Care

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    • cites [41] Aikens, 2012, Prospective associations between emotional distress and poor outcomes in type 2 diabetes, Diabetes Care source

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    • cites [42] Fisher, 2013, REDEEM: a pragmatic trial to reduce diabetes distress, Diabetes Care source

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    Premisecitation

    Common diabetes-specific worries include fear of hyperglycemia, not meeting blood glucose targets, and insulin injections or infusion.

    “Common diabetes-specific concerns include fears related to hyperglycemia (63,64), not meeting blood glucose targets (61), and insulin injections or infusion (65).”
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    • cites [63] Cox, 1987, Fear of hypoglycemia: quantification, validation, and utilization, Diabetes Care source

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    • cites [64] Wild, 2007, A critical review of the literature on fear of hypoglycemia in diabetes: Implications for diabetes management and patient education, Patient Educ Couns source

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    • cites [61] Smith, 2013, Association of diabetes with anxiety: a systematic review and meta-analysis, J Psychosom Res source

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    • cites [65] Zambanini, 1999, Injection related anxiety in insulin-treated diabetes, Diabetes Res Clin Pract source

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    Premisecitation

    Clinically significant psychopathology in people with diabetes varies by diagnostic category, and some diagnoses are much more common than in people without diabetes.

    “Prevalence of clinically significant psychopathology in PWD ranges across diagnostic categories, and some diagnoses are considerably more common in PWD than in those without the disease (47–52).”
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    • cites [47] Anderson, 2001, The prevalence of comorbid depression in adults with diabetes: a meta-analysis, Diabetes Care source

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    • cites [48] McIntyre, 2005, Bipolar disorder and diabetes mellitus: epidemiology, etiology, and treatment implications, Ann Clin Psychiatry source

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    • cites [49] Mezuk, 2008, Depression and type 2 diabetes over the lifespan: a meta-analysis, Diabetes Care source

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    • cites [50] Anderson, 2002, Anxiety and poor glycemic control: a meta-analytic review of the literature, Int J Psychiatry Med source

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    • cites [51] Young-Hyman, 2010, Disordered eating behavior in individuals with diabetes: importance of context, evaluation, and classification, Diabetes Care source

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    • cites [52] Lawrence, 2006, Prevalence and correlates of depressed mood among youth with diabetes: the SEARCH for Diabetes in Youth study, Pediatrics source

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    Premisecitation

    About one-third of adolescents with diabetes develop diabetes distress, which may be linked to declines in self-management and suboptimal blood glucose.

    “About one-third of adolescents with diabetes develop diabetes distress, which may be associated with declines in self-management behaviors and suboptimal blood glucose levels (44).”
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    • cites [44] Hagger, 2016, Diabetes distress among adolescents with type 1 diabetes: a systematic review, Curr Diab Rep source

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    Premisecitation

    The Behavioral Risk Factor Surveillance System estimated the lifetime prevalence of generalized anxiety disorder at 19.5% in people with type 1 or type 2 diabetes.

    “the Behavioral Risk Factor Surveillance System estimated the lifetime prevalence of GAD to be 19.5% in people with either type 1 or type 2 diabetes (62).”
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    • cites [62] Li, 2008, Diabetes and anxiety in US adults: findings from the 2006 Behavioral Risk Factor Surveillance System, Diabet Med source

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    Premisecitation

    Remission of depressive symptoms or disorder in adults suggests that depression recurrence should continue to be monitored in routine care.

    “Remission of depressive symptoms or disorder in adult patients suggests the need for ongoing monitoring of depression recurrence within the context of routine care (53).”
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    • cites [53] Lustman, 1988, Depression in adults with diabetes. Results of 5-yr follow-up study, Diabetes Care source

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    Premisecitation

    Diabetes distress is common and is separate from a psychological disorder.

    “Diabetes distress is very common and is distinct from a psychological disorder (38–40).”
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    • cites [38] Nicolucci, 2013, Diabetes Attitudes, Wishes and Needs second study (DAWN2™): cross-national benchmarking of diabetes-related psychosocial outcomes for people with diabetes, Diabet Med source

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    • cites [39] Fisher, 2012, When is diabetes distress clinically meaningful?, Establishing cut points for the Diabetes Distress Scale. Diabetes Care

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    • cites [40] Fisher, 2010, The relationship between diabetes distress and clinical depression with glycemic control among patients with type 2 diabetes, Diabetes Care source

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    Premisecitation

    For a person with fear of hypoglycemia but no hypoglycemia symptoms, Blood Glucose Awareness Training in routine practice can improve A1C, reduce severe hypoglycemia, and restore hypoglycemia awareness.

    “If FoH is identified and a person does not have symptoms of hypoglycemia, a structured program, Blood Glucose Awareness Training, delivered in routine clinical practice can improve A1C, reduce the rate of severe hypoglycemia, and restore hypoglycemia awareness (70,71).”
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    • cites [70] Cox, 2001, Blood Glucose Awareness Training (BGAT-2), Diabetes Care source

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    • cites [71] Gonder-Frederick, 2011, Psychometric properties of the hypoglycemia fear survey-ii for adults with type 1 diabetes, Diabetes Care source

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    Premisecitation

    Improvements in disease state have been shown to reduce diabetes distress and improve psychological well-being.

    “Such improvements in disease state have been shown to reduce diabetes distress and improve psychological well-being (69,72,73).”
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    • cites [69] Yeoh, 2015, Interventions that restore awareness of hypoglycemia in adults with type 1 diabetes: a systematic review and meta-analysis, Diabetes Care source

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    • cites [72] Walz, 2014, Impact of symptomatic hyoglycemia on medication adherence, patients satisfaction with treatment, and glycemic control in patients with type 2 diabetes, Patient Prefer Adherence source

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    • cites [73] Lopez, 2014, Impact of hypoglycemia on patients with type 2 diabetes mellitus and their quality of life, work productivity, and medication adherence, Patient Prefer Adherence source

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    Premisecitation

    General anxiety predicts injection-related anxiety and is associated with fear of hypoglycemia.

    “General anxiety is a predictor of injection-related anxiety and associated with fear of hypoglycemia (FoH) (64,66).”
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    • cites [64] Wild, 2007, A critical review of the literature on fear of hypoglycemia in diabetes: Implications for diabetes management and patient education, Patient Educ Couns source

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    • cites [66] Mitsonis, 2009, Clinical implication of anxiety in diabetes: a critical review of the evidence base, Eur Psychiatry source

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    Premisecitation

    Parents of children with type 1 diabetes are also prone to diabetes distress, which may affect their ability to support their child psychologically and with diabetes management.

    “Parents of children with type 1 diabetes are also prone to diabetes distress (45), which could impact their ability to provide psychological and diabetes management support for their child.”
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    • cites [45] Hessler, 2016, Understanding the areas and correlates of diabetes-related distress in parents of teens with type 1 diabetes, J Pediatr Psychol source

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    Premisecitation

    Current medical nutrition therapy guidelines recommend flexible, individualized healthy eating patterns rather than labeling many behaviors as dietary nonadherence.

    “Current medical nutrition therapy guidelines promote flexible and healthy eating patterns personalized to the individual rather than defining a wide range of behaviors as dietary “nonadherence” (37).”
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    • cites [37] Evert, 2013, Nutrition therapy recommendations for the management of adults with diabetes

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    Premisecitation

    Binge eating disorder is more likely in people with diabetes than in the nondiabetes population, though prevalence rates in specific diabetes samples vary.

    “Binge eating disorder has been found to be more likely in PWD than in the nondiabetes population, though studies of prevalence in specific diabetes samples show varying rates (77,83).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [77] Papelbaum, 2005, Prevalence of eating disorders and psychiatric comorbidity in a clinical sample of type 2 diabetes mellitus patients, Rev Bras Psiquiatr source

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    • cites [83] Crow, 2001, Binge eating and other psychopathology in patients with type II diabetes mellitus, Int J Eat Disord source

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    Premisecitation

    Bariatric surgery promotes weight loss in severe obesity and often leads to adjunctive remission of type 2 diabetes.

    “Bariatric surgery supports weight loss in people with severe obesity, often with adjunctive remission of type 2 diabetes (129,130).”
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    • cites [129] Inge, 2016, Weight loss and health status 3 years after bariatric surgery in adolescents, N Engl J Med source

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    • cites [130] Keidar, 2011, Bariatric surgery for type 2 diabetes reversal: the risks

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    Premisecitation

    Training family members in problem-solving and conflict resolution can enhance diabetes management and glycemic control, possibly lowering diabetes distress.

    “Teaching family members effective problem-solving and conflict-resolution skills can improve diabetes management and facilitate better glycemic management, with the potential to reduce diabetes distress (92).”
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    • cites [92] Wysocki, 2006, Effects of behavioral family systems therapy for diabetes on adolescents’ family relationships, treatment adherence, and metabolic control, J Pediatr Psychol source

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    Premisecitation

    Technologies like phone and computer data transmission can aid communication through less confrontational means and may let youth communicate directly with providers during transition to greater self-management independence.

    “Emerging technologies, such as phone and computer transmission of management data, can be useful in maintaining communication of information through nonconfrontational channels and may provide a means for youth to communicate directly with care providers as they transition to more independent self-management (100).”
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    • cites [100] Driscoll, 2014, Use of technology when assessing adherence to diabetes self-management behaviors

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    Premisecitation

    Entering adulthood typically involves establishing a work role, intimate partnership, childbearing, and parenting.

    “As people enter adulthood, establishment of a work role, intimate partnering, childbearing, and parenting are typical life tasks (7).”
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    • cites [7] Trief, 2012, Lifespan development issues for adults

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    Premisecitation

    People with visual disability may benefit from low-vision guideline-compliant materials.

    “For example, people with visual disability may benefit from materials that meet low-vision guidelines (128).”
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    • cites [128] American Association of Diabetes Educators (AADE), 2002, Diabetes education for people with disabilities, Diabetes Educ source

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    Premisecitation

    Bariatric surgery candidates are prone to clinically significant body image disorders, sexual dysfunction, and suicidal behavior.

    “People presenting for bariatric surgery have increased rates of depression and other major psychiatric disorders compared with healthy people and are prone to clinically significant body image disorders, sexual dysfunction, and suicidal behavior (131).”
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    • cites [131] Kalarchian, 2007, Psychiatric disorders among bariatric surgery candidates: relationship to obesity and functional health status, Am J Psychiatry source

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    Premisecitation

    Neuropathic chronic pain is associated with psychosocial distress, depression, and sleep problems.

    “Chronic pain from neuropathy is associated with prevalent psychosocial distress, depression, and sleep disturbance (125,126).”
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    • cites [125] Vinik, 2000, Diabetic neuropathies, Diabetologia source

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    • cites [126] Argoff, 2006, Diabetic peripheral neuropathic pain: clinical and quality-of-life issues, Mayo Clin Proc source

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    Premisecitation

    Older adults with diabetes may face age-specific problems such as advanced disease, cognitive dysfunction, complex regimens, comorbidities, functional impairment, limited social and financial resources, and depression.

    “However, older adults may have issues particular to their age, such as advanced disease, cognitive dysfunction, complex treatment regimens, comorbid health conditions, functional impairment, limited social and financial resources, and depression (111).”
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    • cites [111] Kirkman, 2012, Diabetes in older adults

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    Premisecitation

    GLP-1 receptor agonists may assist patients in reaching glycemic goals and controlling appetite, with possible reduction of uncontrollable hunger and bulimic symptoms.

    “Adjunctive medication such as glucagon-like peptide 1 receptor agonists (86) may not only help individuals meet glycemic targets but also help regulate hunger and food intake, thus having the potential to reduce uncontrollable hunger and bulimic symptoms.”
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    • cites [86] Garber, 2012, Novel GLP-1 receptor agonists for diabetes, Expert Opin Investig Drugs source

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    Premisecitation

    Diabetes complications are linked to depression, anxiety, reduced autonomy, role impairment, and lower overall physical function and quality of life.

    “Diabetes complications, including peripheral neuropathy, foot ulcers, limb amputation, diabetic kidney disease, vision impairment, stroke, and heart attack, are associated with depression, anxiety, reduced autonomy, role impairment, and reduced overall physical function and quality of life (119–122).”
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    • cites [119] Vileikyte, 2009, Predictors of depressive symptoms in persons with diabetic peripheral neuropathy: a longitudinal study, Diabetologia source

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    • cites [120] Carrington, 1996, Psychological status of diabetic people with or without lower limb disability, Diabetes Res Clin Pract source

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    • cites [121] Palmer, 2013, Prevalence of depression in chronic kidney disease: systematic review and meta-analysis of observational studies, Kidney Int source

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    • cites [122] Cukor, 2008, Anxiety disorders in adults treated by hemodialysis: a single-center study, Am J Kidney Dis source

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  • May combine two claims.

    Premisecitation

    Preconception counseling for women of reproductive age boosts knowledge of diabetes-related risk, postpones sexual debut, reduces unprotected sex, and improves preconception care and health.

    “Preconception counseling for females during reproductive years increases knowledge about diabetes-related risk, delays age of sexual initiation, decreases unprotected sex, and improves preconception care and health (104,105).”
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    • cites [104] Sereika, 2014, Long-term effects of preconception counseling (PC) during adolescence on family planning vigilance (FPV) in adult women with type 1 diabetes (TID): 15 year follow-up, Diabetes

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    • cites [105] Charron-Prochownik, 2013, Long-term effects of the booster-enhanced READY-Girls preconception counseling program on intentions and behaviors for family planning in teens with diabetes, Diabetes Care source

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    Interpretationnone given

    Diabetes management cannot succeed unless the individual's lifestyle and emotional state are considered.

    “Disease management cannot be successful unless the lifestyle and emotional status of the individual is taken into consideration.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: People with diabetes must master many complex tasks and behaviors to incorporate diabetes care into daily life.

  • Probably not a substantial claim: may not pass S4 (based).

    Interpretationnone given

    Collaborative care is the most promising approach for supporting physical and behavioral health outcomes.

    “Collaborative care shows the most promise for supporting physical and behavioral health outcomes.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning

    Understanding how to evaluate and treat common psychosocial issues affecting people with diabetes can guide routine care.

    “Knowing how to evaluate and treat common psychosocial issues that impact PWD can inform routine care.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Changing laws that mandate minimum standards and payment for diabetes care, plus low-cost insurance covering preventive services, are shifting the balance and enabling practitioners to add previously unsupported services to routine practice.

    “With changing laws mandating minimum standards and payment for diabetes care services (135) and the availability of low-cost insurance that also reimburses preventive services, this balance is changing, allowing the practitioner to incorporate previously unsupported services into routine practice.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [135] Burge, 2014, Diabetes and the Affordable Care Act, Diabetes Technol Ther source

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  • Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.

    Interpretationreasoning

    Integrating psychosocial care and ensuring service access will benefit both people with diabetes and the care team.

    “The integration of psychosocial care and ensuring access to services will benefit the PWD and the care team.”
    Quote in the paperNot a substantial claim
34 of 34

  • The paper relies on this without support.

    Psychosocial factors shape the experience of living with type 1 or type 2 diabetes and the achievement of medical and psychological outcomes.

    “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.”

  • The paper relies on this without support.

    Diabetes medical management depends on patients carrying out a treatment regimen.

    “Medical management of diabetes requires patient implementation of a treatment regimen.”

  • The paper relies on this without support.

    Combining mental and physical health care can improve outcomes.

    “Integrating mental and physical health care can improve outcomes.”

  • The paper relies on this without support.

    Shared resources like electronic health records, management data, and patient-reported information help providers identify and address psychosocial issues that hinder regimen implementation and improve diabetes management and well-being.

    “Shared resources such as electronic health records, management data, and patient-reported information regarding adjustment to illness and life course issues facilitate providers’ capacity to identify and remediate psychosocial issues that impede regimen implementation and improve diabetes management and well-being.”

  • The paper relies on this without support.

    Fear of hypoglycemia may account for avoidance of glucose-lowering behaviors such as increasing insulin doses or monitoring frequency.

    “FoH may explain avoidance of behaviors associated with lowering glucose such as increasing insulin doses or frequency of monitoring.”

  • The paper relies on this without support.

    OCD symptoms may reflect generalized anxiety or may be specific to diabetes.

    “OCD symptoms can represent generalized anxiety or be diabetes specific,”

  • The paper relies on this without support.

    Behavioral health provider support may be effective when difficulties persist.

    “Support from a behavioral health provider may be effective when difficulties are persistent.”

  • The paper relies on this without support.

    Confounders in identifying disordered eating symptoms include prescribed treatment behaviors, disease-related behaviors or effects, and adverse treatment effects like excessive hunger from hypoglycemia.

    “Potential confounders to the identification of symptoms of disordered eating are behaviors that are prescribed as part of treatment (e.g., carbohydrate counting and calorie restriction), behaviors or effects that are part of the disease (e.g., loss of control over satiety regulation secondary to disease processes), and adverse effects of treatment such as excessive hunger secondary to hypoglycemia”

  • The paper relies on this without support.

    Missed insulin injections from poor self-management are significantly different from deliberate medication omission for weight loss.

    “For example, missed insulin injections as a result of suboptimal self-management differ significantly from intentional medication omission to produce weight loss.”

  • The paper relies on this without support.

    Early detection of depression, anxiety, eating problems, and learning disabilities in youth broadens and improves treatment options and may reduce negative effects on diabetes management and outcomes.

    “Given the rapid and dynamic nature of cognitive, developmental, and emotional changes in youth, early detection of depression, anxiety disorders, eating issues, and learning disabilities enhance the range and effectiveness of potential treatment options and may help to minimize adverse effects on diabetes management and disease outcomes.”

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    Youth rely on social support systems (family and providers) and will eventually need to transition to independent diabetes self-management.

    “Because youth are dependent on social support systems (family and care providers) and must eventually transition to independent diabetes self-management, their families and related social networks need to be included in psychosocial assessment and treatment (92–94).”

  • The paper relies on this without support.

    Adolescence is known for disruptions in diabetes care and communication among family, youth, and providers.

    “The adolescent years are known for disruption in diabetes care and communication between family members, youth, and providers.”

  • The paper relies on this without support.

    Normal adolescent development includes greater independence in decision making and reliance on peers for self-concept and self-worth validation.

    “Hallmarks of normal adolescence are increased independence in decision making and turning to the peer group for validation of self-concept and self-worth.”

  • The paper relies on this without support.

    Open, factual discussions about sexual health make youth more comfortable disclosing sexual function concerns later.

    “Open and factual discussions of these topics facilitate future comfort in disclosing any concerns regarding sexual function.”

  • The paper relies on this without support.

    Attendance at diabetes care visits is typically less frequent in the 18- to 30-year-old age group.

    “As less frequent attendance to diabetes care visits is typical in the 18- to 30-year-old age-group, screening regarding risk behaviors may be necessary at each visit.”

  • The paper relies on this without support.

    Living with and self-managing diabetes is expected to affect all life-course decisions for people with diabetes and their partners.

    “Living with and self-managing diabetes can be expected to impact all life-course decisions for PWD and their partners.”

  • The paper relies on this without support.

    Sexual dysfunction is often linked to depression and is commonly reported in clinical encounters.

    “Sexual dysfunction is often associated with depression and is routinely reported in clinical encounters (see depression).”

  • The paper relies on this without support.

    Some older adults with diabetes are functional and cognitively intact with significant life expectancy and may not need psychosocial care beyond that of younger adults.

    “Older adults with diabetes may be functional and cognitively intact and have significant life expectancy, and they may not require psychosocial care beyond that of younger adults.”

  • The paper relies on this without support.

    Glycemic target achievement may be affected by unique nutritional needs, physical limitations such as reduced sensation, memory loss, and low literacy and numeracy.

    “Meeting glycemic targets may be impacted by unique nutritional requirements, physical limitations (such as reduced sensation), memory loss, and low literacy and numeracy skills.”

  • The paper relies on this without support.

    The onset of diabetes complications threatens independence, self-image, and quality of life.

    “Onset of diabetes complications threatens independence, self-image, and quality of life.”

  • The paper relies on this without support.

    People with diabetes must master many complex tasks and behaviors to incorporate diabetes care into daily life.

    “PWD must master many complex tasks and behaviors to successfully incorporate diabetes care into daily life.”

  • The paper relies on this without support.

    Challenges to achieving this standard of care are considerable, including too few qualified mental health professionals familiar with diabetes and medical care models unsuited to team care.

    “Challenges to accomplishing this standard of care are considerable, including too few qualified mental health professionals who understand living with diabetes and medical care models that are not conducive to team care.”

  • The paper relies on this without support.

    The recommended psychosocial services are reimbursable for mental health providers in routine medical care under CMS.

    “The psychosocial services recommended are reimbursable for mental health providers in routine medical care under Centers for Medicare & Medicaid Services (CMS).”

  • The paper relies on this without support.

    New CMS reimbursement is planned for the Collaborative Care Model in routine care.

    “In addition, new CMS reimbursement is planned for the Collaborative Care Model in routine care.”
24 of 24

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • The American Diabetes Association identified diabetes self-management education and ongoing support as the first-line intervention for diabetes distress.

    “In its inaugural Position Statement on Psychosocial Care for People with Diabetes, the American Diabetes Association identified diabetes self-management education and ongoing support (DSME/S) as the first-line intervention for DD (29).”

    From Addressing emotional distress to improve outcomes in adults with type 1 diabetes: Protocol for ACT1VATE randomized controlled trial (2024) · cites this paper as [29]

    The Diabetes Distress section recommends referral for tailored diabetes education when distress is identified, followed by behavioral-health referral if self-care remains impaired. This supports education as an initial step, but the passage does not identify ongoing support (DSME/S) as part of that first-line intervention. (LLM, conf=0.85)

    Experimental — accuracy not yet measured

  • Diabetes Canada, the American Diabetes Association, and the International Society for Pediatric and Adolescent Diabetes recognized the burdens and complexity of diabetes management and suggested psychosocial support be a standard part of diabetes care.

    “Diabetes Canada, along with the American Diabetes Association and the International Society for Pediatric and Adolescent Diabetes, recognized the burdens and complexity of efforts required to manage diabetes and suggested psychosocial support be a standard part of diabetes care (4”

    From Life With Diabetes Does Not Occur in a Vacuum: Considering Mental Health (2022) · cites this paper as [4]

    Split into 2 atoms — 1 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

    Experimental — accuracy not yet measured

  • People with diabetes are more likely to exhibit depression, anxiety, serious mental illness, disordered eating, stress- and trauma-related disorders and sleep disorders compared with those without diabetes.

    “People with diabetes are also more likely to exhibit depression, anxiety, serious mental illness, disordered eating, stress- and trauma-related disorders and sleep disorders, compared with those without diabetes (2–4”

    From Life With Diabetes Does Not Occur in a Vacuum: Considering Mental Health (2022) · cites this paper as [4]

    The Psychological Comorbidities section says some psychiatric diagnoses are more common in people with diabetes than in those without it, and the Disordered Eating section specifically reports a higher likelihood of binge eating disorder. The paper discusses depression, anxiety, PTSD, and serious mental illness, but does not establish the claimed diabetes-versus-nondiabetes comparison for every listed condition; the retrieved passages do not support it for sleep disorders. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • Multifaceted domains, including heterogeneity across individual characteristics, social determinants of health, and psychosocial factors, challenge individuals with diabetes, their families, and their providers when attempting to integrate diabetes care into daily life.

    “Thus, these multifaceted domains (heterogeneity across individual characteristics, social determinants of health, and psychosocial factors) challenge individuals with diabetes, their families, and their providers when attempting to integrate diabetes care into daily life (49).”

    From Management of Hyperglycemia in Type 2 Diabetes, 2022. A Consensus Report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) (2022) · cites this paper as [49]

  • Clinical guidelines underscore the importance of applying information about patients' social risk to inform care decisions, such as when to test for tuberculosis or offer specific vaccinations.

    “several clinical guidelines underscore the importance of applying information about patients’ social risk (e.g., information about housing or incarceration status) to inform care decisions, such as when to test for tuberculosis or offer specific vaccinations. 46 , 47 , 48”

    From Revising the logic model behind health care's social care investments (2024) · cites this paper as [48]

Cites

Flagged first, then by citations

1 of the 130 references couldn’t be matched to a known paper.

Research works printed but not linked: 9

  1. Trief, 2012, Lifespan development issues for adults, 251
  2. Wysocki, 2012, Special Issues in children and adolescents, 229
  3. Umpierre, 2011, Physical activity advice only or structured exercise training and association with HbA1c levels in type 2 diabetes: a systematic review and meta-analysis, JAMA, 305, 1790, 10.1001/jama.2011.576 · DOI · Paper page
  4. Rubin, 2012, Psychosocial adjustment to diabetes and critical periods of psychological risk, 219
  5. Lopez, 2014, Impact of hypoglycemia on patients with type 2 diabetes mellitus and their quality of life, work productivity, and medication adherence, Patient Prefer Adherence, 8, 683, 10.2147/ppa.s58813 · DOI · Paper page
  6. Driscoll, 2014, Use of technology when assessing adherence to diabetes self-management behaviors, 521
  7. Sereika, 2014, Long-term effects of preconception counseling (PC) during adolescence on family planning vigilance (FPV) in adult women with type 1 diabetes (TID): 15 year follow-up, Diabetes, 63, A198
  8. Wouters, Psychological issues in the management of diabetes and pregnancy
  9. Hill-Briggs, 2012, Diabetes-related functional impairment and disability, 273

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Authors
Young-Hyman, D., de Groot, M., Hill-Briggs, F., Gonzalez, J. S., Hood, K., & Peyrot, M.
Affiliations
  • National Institutes of Health (US)
  • Indiana University School of Medicine, Indianapolis, IN
  • Johns Hopkins School of Medicine, Baltimore, MD
  • Albert Einstein College of Medicine (US)
  • Stanford University (US)
  • Loyola University Maryland (US)
Corresponding author
Young-Hyman, Deborah
ORCID
Venue
Diabetes Care
Publisher
American Diabetes Association
Published
2016-11-10
Volume
39
Issue
12
Pages
2126-2140
ISSN
  • 0149-5992 (ISSN-L)
  • 1935-5548
DOI
10.2337/dc16-2053
PMC
PMC5127231
OpenAlex
W2556561633
Cited by
1,072
References
130
Citations by year
2026: 94 · 2025: 108 · 2024: 106 · 2023: 100 · 2022: 135 · 2021: 157 · 2020: 132 · 2019: 96 · 2018: 74 · 2017: 59 · 2016: 9 · 2013: 1
FWCI
11.65
Type
journal article
Language
en
Update notices
Open access
Licence
www.diabetesjournals.org/content/license (vor, 12 d)
Locations
  • Diabetes Care (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • Eli Lilly and Company
  • AstraZeneca
  • GlaxoSmithKline
  • Bigfoot Biomedical
  • Dexcom
  • Novo Nordisk
  • National Institutes of Health
  • Genentech
  • National Institute of Diabetes and Digestive and Kidney Diseases (R18DK098742, R01DK104845, R18DK092765, P30DK020541, P30DK097512, P30DK111022)
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
  • Health Sciences › Medicine › Oncology › Cancer survivorship and care
Keywords
psychosocial care, diabetes mellitus, type 1 diabetes, type 2 diabetes, diabetes distress, depression, anxiety, disordered eating, psychological comorbidity, patient-centered care, psychosocial screening, self-management behavior, family caregivers, health-related quality of life, special populations, patient values and preferences

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-09-28.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-09-28.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

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