In part 2 of this Exclusive Interview, Kathryn Kreider talks with Diabetes in Control Publisher Steve Freed about the signs of diabetes distress and the impact of this distress on A1C.
Kathryn Kreider is an Assistant Professor at Duke University School of Nursing in Durham, NC.
Transcript of this video segment:
Freed: So, diabetes distress, what do you look for in a patient? Assuming that everybody has it, but I’m sure there are certain elements that you can look for. Some people can deal with it, some people can’t deal with it. What do you look for when a patient comes in who’s been diagnosed prior, so that you can see what you need to do for that patient?
Kreider: Yeah, great question. So, diabetes distress, the different emotions that patients will report, are things like feeling burned out. They feel overwhelmed. They might feel guilty. They might feel afraid. So, there’s all kinds of — there’s a range of things that they could tell you. Those are some examples of things they might say. In contrast, they may not verbalize that to you. They might demonstrate lack of self-care behaviors or lack of adherence to medications and those actions can also be signs of diabetes distress. So, it’s important to ask patients an open-ended questions about how they’re doing with diabetes and how they’re managing day to day, so that you can gauge their level of potential distress related to diagnosis or complications or management.
Freed: Do you see that distress plays an important role in outcomes, specially their A1C?
Kreider: Absolutely. So, there’s a good amount of literature that shows a significant positive co-relation between high diabetes distress levels and high A1C. And this has also been shown to be malleable over time, so that patients who reduce their diabetes distress may then reduce their A1C, so that’s a very important clinical outcome that’s associated with diabetes distress. Also, other studies have shown poor quality of life related to high diabetes distress, poor self-management behavior such as less exercise, poor diet choices, those kinds of things that are related to high diabetes distress.
Freed: Do you see more distress, serious distress, [in] type 1 or type 2?
Kreider: That’s a great question. We don’t know exactly the answer to that. So, most of the studies have been done primarily in type 2 patients. There are also studies in type 1. Type 1 does not necessarily demonstrate higher distress. They both have about the same incidents and prevalence so far based on what we know. We do need more literature and studies that show differences potentially in symptomatology in type 1 and type 2 patients and also in treatment options for diabetes distress.