ARTICLE: Response to Comments on Young-Hyman et al. Psychosocial Care for People With Diabetes: A Position Statement of the American Diabetes Association

AUTHORS: Deborah Young-Hyman, Mary de Groot, Felicia Hill-Briggs, Jeffrey Gonzalez, Korey Hood and Mark Peyrot

JOURNAL: Diabetes Care. 2017 Sep;40(9):e131-e132. doi: 10.2337/dci16-0051.

Thanks to Drs. Kalra, Balhara, Mezuk, Pouwer, and Campbell and Ms. Macdonald for their careful consideration (13) of the first American Diabetes Association (ADA) psychosocial guidelines Position Statement (4). Kalra and Balhara (1) note the overlaps and differences in the content of the ADA and Indian position statements, with particular emphasis on the cultural appropriateness and specificity of recommendations. Mezuk and Pouwer (2) question the need for routine screening for depression in persons with impaired glucose metabolism and undiagnosed diabetes based on meta-analytic results (5) and note the need to address disparities in diabetes burden and quality of care. They further suggest the need for action steps for practitioners once psychosocial issues are identified that impact health outcomes. These concerns are echoed by Macdonald and Campbell (3) when identifying that emphasis on compliance can cause blame to be placed on patients through misguided interpretation of the patient-centered paradigm. They suggest that this might be avoided through “long-term” care, by which they appear to mean the relationship formed through long-term follow-through by a consistent care provider.

These authors identify social issues that are not explicitly addressed in the ADA Position Statement: barriers to getting married, gender-based issues, geographically based management challenges, culturally specific intervention strategies for increasing well-being, disparities in burden and quality of care for racial/ethnic minorities, and the need for relationship-based care, i.e., provider understanding of personal needs rather than only reliance on treatment algorithms. The importance of individual needs and cultural context is thereby emphasized. Whether with regard to phase of life, availability of medical resources, and/or broader cultural issues that are endemic and therefore interact with care, no one set of guidelines or recommendations will be applicable to all people affected by this global epidemic. Thus, person-based and contextual factors must always be considered in order to optimize treatment and outcomes (4).

As noted, some content areas such as compassion fatigue of caregivers, provider assumptions regarding burden of care and burnout, and drug addiction were not included in the ADA Position Statement. This first Position Statement was limited to topics regarding psychosocial issues with evidence-based literature that included problem prevalence and effective treatment approaches and that provided support for recommendations. It is our expectation that additional evidence-based reviews and future position statements will address special topics and populations not covered in this first statement. The need for tested interventions to remediate disparities in burden of care, delivery, and quality of care is particularly critical given exponential increases in global diabetes prevalence (6).

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