Why We Shouldn't Overlook Psychosocial Issues In Patients With Diabetes

Author(s): 
By Thomas Zgonis, DPM, and Gary Peter Jolly, DPM
Preventing complications associated with diabetes is always preferable to treatment. Newly diagnosed diabetics should not only be educated about dietary adjustments, self-monitoring of blood glucose and exercise, but also should be specifically counseled by their primary care physicians on the potential for depression. Physicians should address depression shortly after the diagnosis of diabetes and they should recommend emotional support for the patient and their families far more often than they do. Diabetic foot infection is one of the major reasons for hospital admissions. To the health care provider, it is likely to represent just another admission, one that may result in a trip to the operating room and possible amputation. As surgeons involved with busy inpatient services, it is easy for us to forget the patient’s stress and anxiety associated with such an admission. It is less the potential loss of a leg but rather the way in which it is revealed to the patient that will ultimately determine the patient’s acceptance of events. Even though it is sometimes out of our reach to help save a foot or limb, providing a source of emotional support for patients with diabetes is essential at the beginning of their treatment. Healthcare providers are often astonished by the fact that their diabetic patients refuse to consent to an amputation until the foot is grossly infected and has become frankly septic. Their resistance is often falsely supported by the absence of pain as well as their concerns about living alone as an amputee, their ability to continue to provide for themselves and their families, and other concerns they might not be able to articulate. Final Notes Clearly, the multidisciplinary team approach is the best way of handling the needs of patients with diabetes. Early interventions, such as yearly eye and foot examinations, maintainance of tight glycemic control, urinalysis and screening for microalbuminemia, testing for hyperlipidemia and hypertension, exercise, smoking cessation, application of a healthy diet and weight loss are all essential elements for reducing the complications of diabetes. However, we also should not overlook the importance of an early assessment of the patients’ understanding of their disorder and their ability to cope with the disorder. Dr. Zgonis is an Adjunct Assistant Professor of Surgery at the College of Podiatric Medicine and Surgery at Des Moines University in Des Moines, Iowa. He is the Associate Director of the PGY-5 Fellowship in Reconstructive Foot And Ankle Surgery at New Britain General Hospital in New Britain, Ct. Dr. Zgonis is an Associate of the American College of Foot and Ankle Surgeons. Dr. Jolly is the President of the American College of Foot and Ankle Surgeons. He is the Chief of Podiatric Surgery and is the Director of the PGY-5 Fellowship in Reconstructive Foot and Ankle Surgery at New Britain General Hospital in New Britain, Ct. Dr. Jolly is a Clinical Professor of Surgery at the College of Podiatric Medicine and Surgery at Des Moines University in Des Moines, Iowa. Dr. Steinberg (pictured) is an Assistant Professor in the Department of Orthopaedics/Podiatry Service at the University of Texas Health Science Center.
 

 

References:

References 1. Rubin RR, Peyrot M. Psychological issues and treatments for people with diabetes. J Clin Psychol. 2001;57(4):457-78 2. Polonsky WH. Emotional and quality-of-life aspects of diabetes management. Curr Diab Rep. 2002;2(2):153-9. 3. Harris MD. Psychosocial aspects of diabetes with an emphasis on depression. Curr Diab Rep. 2003;3(1):49-55. 4. Cox S. How I coped emotionally with diabetes in my family. Prof Care Mother Child. 1994;4(5):139-41.

 

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