Summary And Conclusions

In this chapter I have reviewed counselling and psychotherapeutic interventions for patients with diabetes who are having difficulties coping with the day-to-day demands of life with diabetes, and for patients with diabetes who suffer from frank psychopathology, specifically depression, anxiety disorder or eating disorder. Since the effects of coping problems and psychological disorders may be especially malevolent for people with diabetes, effective psychological treatment is especially important for these individuals. Psychological problems of any magnitude may affect metabolic control directly via the neuroendocrine and physiological effects of stress, or indirectly via a cascade of events, including worsened self-care and deteriorating metabolic control, which may in turn exert a negative reciprocal effect on emotional well-being. This downward spiral can lead to acute life-threatening medical crises, and may also accelerate the long-term complications of diabetes. Thus, psychological problems represent a clear and present danger to many people with diabetes, and the need to effectively address these problems in susceptible individuals is equally clear.

Unfortunately, the literature offers a few unequivocal treatment guidelines. The number of published intervention studies is small, and many studies which have been published utilized small or unrepresentative samples, and therefore lack rigour and statistical power. Many studies do not include a control group or follow-up measures, so we can not say with confidence that the intervention was effective or enduring. Studies often describe comprehensive interventions which incorporate a variety of medical and psychological components. While this approach maximizes the likelihood of effective treatment, it makes the attribution of observed benefits to particular components of the intervention impossible.

Despite these limitations, the existing literature does provide some guidance for clinicians treating coping difficulties and psychological disorders in people with diabetes. We find some evidence for the benefits of formal and informal coping skills training, utilized as a unique inter-vention21'30'31'35 or as part of a comprehensive psycho-educational program40'43'44. We also find some evidence that BART may facilitate stress management and glycaemic control in those with type 2 diabetes8-10 and in

Diabetes 2

Diabetes 2

Diabetes is a disease that affects the way your body uses food. Normally, your body converts sugars, starches and other foods into a form of sugar called glucose. Your body uses glucose for fuel. The cells receive the glucose through the bloodstream. They then use insulin a hormone made by the pancreas to absorb the glucose, convert it into energy, and either use it or store it for later use. Learn more...

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