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FIGURE 1 Problem areas in diabetes scale. Source: From Ref. 41.

FIGURE 1 Problem areas in diabetes scale. Source: From Ref. 41.

regularly to good effect in all areas of diabetes management. Referral can be made if appropriate to a diabetes nurse educator or other available member of the diabetes clinical team to tackle specific practical issues arising from the emotional concerns identified by the patient (e.g., fear of complications, difficulties with the diet plan). The U.K. Prospective Diabetes Study (UKPDS) (37) has demonstrated the benefit of improved blood glucose control on progression of complications in type 2 diabetes. Screening for diabetes emotional distress and intervening where a high level of distress is present will support patient self-care efforts that, in turn, will contribute to improved blood glucose control (30). Recently, the diabetes attitudes, desires, and needs (DAWN) study was launched across 13 countries with the goal to enhance communication between people with diabetes and their healthcare providers using a brief empathic listening intervention (understanding what the patient is saying, thinking, and feeling through open questions, reflective listening, and brief summaries of what was heard) (42). A focus on understanding the patient's perspective is an important first step in providing support to the patient experiencing high emotional distress living with diabetes as this strengthens rapport and trust and can help identify the most important issues to focus on from the patient's perspective.

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