Why We Shouldn't Overlook Psychosocial Issues In Patients With Diabetes
Diabetes mellitus is said to be a disorder of glucose metabolism, but it can be so much more for those individuals who have the disease and the families with whom they share their lives. The sequelae of diabetes involve vascular changes in the large and small vessels, and produce disorders of the retina, the kidneys and the coronary arteries, not to mention the peripheral vascular tree. While serum glucose management is critical, it is only one part of the total picture in managing patients with diabetes.
In order to adequately protect the patient from the ravages of diabetes, a well-integrated team of specialists is essential. In addition to the internist or endocrinologist, a vascular surgeon, podiatrist, reconstructive foot and ankle surgeon and an infectious disease specialist are required to adequately manage the inpatient issues that may arise when a patient with diabetes is admitted to the hospital.
However, even in centers where such integrated team approaches are practiced, there are still certain deficiencies in patient management. I am specifically referring to the lack of understanding and lack of sensitivity toward the psychosocial issues that can influence a patient’s response to intervention.
Inherent to these problems are also the effects that chronic disease manifests on the patient’s family and on the interpersonal relationships within that family. As physicians treating patients with a particular disorder, particularly one with as broad a range of complications as diabetes produces, it is essential to be cognizant of the behavioral component of managing these patients.1,2
As with any disease, the initial response from a patient after diagnosis may be denial, mood swings, anger and disbelief. Clinical depression is not uncommon. Physicians and particularly surgeons tend to lose sight of our patients’ psychosocial needs as they pertain to chronic diseases and the impact these diseases have on their interpersonal relationships. Patients with diabetes, particularly those patients who are compliant and try to take care of themselves, engage in a daily battle of balancing tight glycemic levels and a satisfying quality of life.
This internal battle can, at times, be devastating. Physicians might be surprised that their patients’ denial and resistance to treatment may be due to their withdrawl from reality and an inability to make emotional adjustments in order to cope with their disease. The fear of potential limb loss, the risk of blindness and the possibility of lower extremity amputation may precipitate a major depression, dysfunctional family relationships and, ultimately, the avoidance of healthcare altogether.
Patient education, the prevention of complications and adequate glycemic control are classically regarded as the three pillars in the management of diabetic patients. However, treating physicians should not overlook the management of the fears and anxieties that often accompany chronic diseases.