Diabetes Distress: Aim for Small Achievable Goals

You know how to manage diabetes, but do you know whether your patient has diabetes distress? And do you know what strategies can be effective when your patient is distressed because he or she has been unable to achieve his A1c goal?

Here to discuss the case of Mr S, a truck driver whose type 2 diabetes has spiraled dangerously out of control, and who has diabetes distress is Edward Shahady, MD, Medical director of the Master Diabetes Program and Clinical Professor at the University of Miami.

Mr S is a 43-year-old African-American with 6-year history of T2 diabetes. He also has hypertension and hyperlipidemia. Medications include losartan, metropolol, pravastatin, metformin, amlodipine, and glimepiride.

His numbers are not at goal: A1c 11.3; BP 150/100; HDL, 29; triglycerides, 228; LDL, 90. Only a few years ago, his A1c was 6.8, but over the past few years, things have deteriorated.

Mr S refuses to take insulin. He is a truck driver, and says that he would lose his job if he were to do so. He does his own cooking, but frequently eats at truck stops, and doesn’t follow a good diet. He also admits he often skips his medications.

A numeracy questionnaire reveals that Mr S can’t read or understand labels, so counting calories or calculating dosages is very difficult for him.

Many patients, like Mr S,  have diabetes distress -- associated with the inability to reach one’s A1c goal. A diabetes distress questionnaire reveals that he is scared and angry and anxious about having to deal with diabetes, and that he expects to lose his limbs and life to the disease, just as several of his family members have-at relatively early ages.

Diabetes distress is often confused with depression, and antidepressants are not effective for it.

Mr S’s diabetes distress needs to be addressed, or no therapy will be effective.

Here, Dr Shahady talks about strategies to help a distressed patient, and to help overcome barriers to doing the things he/she needs to do to get the disease –- and the distress -- under control.

You can download a copy of the Distress Questionnaire at Dr Shahady’s website.