DUKPC highlights part 3: Diabetes and mental wellbeing – by Lucy Trelfa
Diabetes is demanding and complex. Whether it’s adjusting to being diagnosed, or trying to juggle diabetes with other long-term health conditions, getting the right emotional support alongside physical support is vital. There was no shortage of talk around mental health at this year’s DUKPC.
Diabetes and severe mental illness
People with a severe mental illness – like schizophrenia or bipolar disorder – are almost three times more likely to have diabetes and are more at risk of diabetes-related complications than other people with diabetes.
We heard the latest on new research that’s exploring the psychological impact – does living with diabetes bring additional emotional and social difficulties for people with a severe mental illness?
Diabetes UK-funded researcher Dr Najma Siddiqi, and Dr Jo Taylor, surveyed people with both diabetes and severe mental illness living in England and compared their responses to people with diabetes who didn’t have mental illness.
They found that living with diabetes takes a greater toll on wellbeing and quality of life for people who also have a severe mental illness. This group were more likely to experience high levels of diabetes distress (42% vs 27%), and to report negative impacts from diabetes on their physical health (69% vs 59%), work or studies (43% vs 23%) and emotional wellbeing (58% vs 47%), compared to people with diabetes who don’t have a severe mental illness.
Despite this, people with both conditions reported receiving less support, from both healthcare professionals and their family and friends, and were less likely to have attended structured diabetes education.
These findings highlight the even greater demands and challenges for those living with severe mental health conditions, and will be important to help researchers tailor diabetes care and find better ways to support these individuals in future.
Physical clues of mental health conditions
Consistently high blood glucose levels can lead to a condition called diabetic ketoacidosis (DKA). DKA is usually avoidable, but left unchecked, it can be life-threatening.
We heard from Dr Chris Garrett, a diabetes psychiatrist, who discussed how recurrent episodes of DKA could be a sign of an untreated mental health condition. He found that people with Type 1 diabetes who are frequently in hospital with DKA have increased levels of diabetes distress and anxiety, and are more likely to have a personality disorder.
This was just the tip of the iceberg. Dr Garrett suggested that other clinical information can help you to build a picture around someone’s relationship with their diabetes. For example, their blood glucose levels, the number of hospital appointments they have had, or how many appointments they have missed can all be used to help spot people who may need mental health support.
DKA can be life-threatening, but it’s also avoidable. The fact that some people return to hospital with DKA more than once suggests that addressing the physical aspects isn’t enough – we need to look at the whole picture, and make sure mental wellbeing is also a priority.
Kate Hardenberg, a specialist psychotherapist in diabetes, supported Dr Garrett’s findings. She believes healthcare professionals should be working alongside people with Type 1 diabetes who frequently have DKA, to see the condition from their perspective. She believes psychotherapy is one way of doing this – understanding somebody’s individual needs and focusing emotional support on those areas.
This approach would require specialist support from a psychotherapist, but healthcare professionals could still do more to open up conversations, and get to know their patient’s relationship with their diabetes. And doing this early on means that people can get any help they need might need sooner.
This hasn’t gone unnoticed by Diabetes UK.
The Diabetes and Emotional Health Guide
We work closely with healthcare professionals at Diabetes UK, and they’ve told us that they struggle to support their patients living with diabetes around their emotional needs.
Inspired by a handbook written by expert mental health clinicians in Australia, at DUKPC 2018 we pulled together a group of mental health experts to work out how to equip healthcare professionals here in the UK with the tools and skills they need.
This tight knit and hardworking group have worked together over the last year since, and came up with ‘Diabetes and emotional health’ – a practical guide for health professionals to support the emotional health of adults with Type 1 and Type 2 diabetes.
The guide includes strategies and tools for how to recognise and have conversations about emotional problems, as well as for providing appropriate support. There are dedicated chapters on common emotional issues, such as eating problems, depression, diabetes distress and adjusting to life with diabetes.
There’s advice on how to use consultation time more effectively and to know when to refer on. Importantly, the guide also highlights the best language to use around diabetes throughout all of this, and signposts to the Language Matters position statement that we supported NHS England with.
At this year’s DUKPC, we were ready to launch the guide. And what a launch it was. Over 100 clinicians attended. Given the number of competing sessions running, this clearly illustrates the interest and enthusiasm there is for help in this area of diabetes care.
Now, the challenge ahead is to get the ‘Diabetes and emotional health’ guide out to as many healthcare professionals as possible. It’s a small step, and there’s much more to do, but we hope the guide will help those living with diabetes get the support they need for their emotional health.
That’s the end of our DUKPC 2019 round up blogs. If you want to hear what happens at our professional conference straight from the experts themselves, you can do just that at our Insider event. Keep an eye out for registration details on our website. See you in Glasgow, DUKPC 2020!