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Mark Peyrot Part 3, Key Recommendations for Psycho-Social Diabetes Guidelines

In part 3 of this Exclusive Interview, Mark Peyrot talks with Diabetes in Control Publisher Steve Freed during the ADA meeting in San Diego, CA about the key facets to the guidelines and how healthcare providers can use them to help in the care of their patients.

Mark Peyrot is Professor of Sociology at Loyola University Maryland and Professor of Health and Social Sciences at Bergen University College (Norway). His 300+ publications include a co-edited collection of diabetes psychosocial care guidelines and a ADA position statement on diabetes psychosocial care recently published by ADA.

Transcript of this video segment:

Steve: What are some of the key recommendations?

Dr. Peyrot: There are 5 key recommendations, major ones, that are over-arching, that cover everything. In the position statement, we also go into a number of sub-areas, and give a number of more specific focused guidelines for how they should work.  One of the very first ones is dealing with the mental health states of people with diabetes.  We know that diabetes has a lot of comorbidity with psychological distress, whether it be depression, anxiety, diabetes-related distress, and variety of problems with managing diabetes.  We said we need to deal with these, not merely when they are diagnosable, but also when they are sub-clinical levels, which are already disturbing people’s quality of life and the ability to take care of themselves. Another aspect that we talk about is diabetes self-management. We know that people may have good intentions, but it may be difficult for them to try and achieve their goals. We feel that the best way to help patients take better care of themselves is to understand what kinds of barriers and problems they are facing and then help them deal with those barriers.  So, looking at both mental and physical health.

Steve: Are these guidelines for psychologists, diabetologists, or where most patients go with type 2 diabetes and that is PCPs?

Dr. Peyrot:  That is a very good question. I think in the past what has tended to happen is that anything that seems to involve the psychological aspect has been turfed to the mental health professionals. The problem is, there is not enough of them to really be able to handle all the patients who need help with these sorts of problems.  The standards are written in a way that they help the PCPs and anyone else who is the primary care for a person with diabetes, because some people get their primary care from a diabetologist, especially people who have complex disease conditions like type 1 diabetes, or complications. So whoever is that first-line person who is providing care to that patient, and it may even be CDEs in some cases, they need to understand what those issues are, and one of our things is you need to screen for it. You cannot help deal with the problem if you don’t know that it exists. We have suggestions for when and under which circumstances they ought to screen for these kinds of problems. And then to take an integrated strategy, which is to try to do what they can do, to deal with these problems.  That may not be providing psychological treatment, but it may be to help patient think about the things that are troubling their life and to try find ways to get over those barriers.  How to deal with the pain of taking an injection?  How to deal with the fear of hypoglycemia? These are the kinds of things that healthcare providers, PCP’s and others, can work with the patient on and have a relatively short and focused interaction that may be adequate in itself. But, if it’s not adequate, then they need to track the fact that this hasn’t worked and that something more is required, just like with any other health condition. If the PCP can’t take care of it themselves, it is at that point that they need to make a referral. One of the guidelines, one of the recommendations is that they need to do it when it’s detected. To not let it be a thing that lingers on for years and years before it gets any attention, but to recognize it when it occurs, to try to intervene, and if that intervention is not successful, to refer them to somebody who has got more expertise in working with these kinds of problems.

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