Evidence-base - International Diabetes Federation

More documents

Recommendations

Info

4 PSYCHOLOGICAL CARE Recommendations Recommended care PS1 In communicating with a person with diabetes, adopt a whole-person approach and respect that person’s central role in their care (see Chapter 3: Education and Chapter 5: Lifestyle management). Communicate non-judgementally and independently of attitudes and beliefs. PS2 Explore the social situation, attitudes, beliefs and worries related to diabetes and self-care issues. Assess well-being (including mood and diabetes distress), periodically, by questioning or validated measures (e.g. WHO-5 [1] ). Discuss the outcomes and clinical implications with the person with diabetes, and communicate findings to other team members where appropriate. PS3 Counsel the person with diabetes in the context of ongoing diabetes education and care. PS4 Refer to a mental health-care professional with a knowledge of diabetes when indicated. Indications may include: severe coping problems, signs of major depression, anxiety disorder, personality disorder, addiction and cognitive decline. Limited care PS L 1 The communication principles as for Recommended care. PS L 2 Be alert to signs of cognitive, emotional, behavioural and/or social problems which may negatively impact quality of life and complicate self-care, particularly where diabetes outcomes are sub-optimal. PS L 3 Refer for mental health specialist advice according to local availability of such professionals. Comprehensive care PS C 1 The communication principles as for Recommended care. PS C 2 A mental health specialist (psychologist) would be included in the multidisciplinary diabetes care team. PS C 3 Periodic assessment and subsequent discussion would be as for Recommended care, but could use additional measures [2-4] and computer-based automated scoring systems. The mental health specialist in the team would be able to provide a more comprehensive (neuro)psychological assessment, if indicated. 4 PSYCHOLOGICAL CARE 27
Global Guideline for Type 2 Diabetes 28 PS C 4 Counselling would be as for Recommended care, but the mental health specialist in the team would be available to offer psychological counselling/ psychotherapy, to participate in team meetings, and to advise other team members regarding behavioural issues. Rationale Psychological well-being is itself an important goal of medical care, and psychosocial factors are relevant to nearly all aspects of diabetes management. It is important to acknowledge that well-being encompasses both physical and mental health. Being diagnosed with diabetes imposes a life-long psychological burden on the person and his/her family. Having diabetes can be seen as an additional risk factor for developing psychological problems. Indeed there is evidence that the prevalence of mental health problems in individuals with diabetes exceeds that found in the general population. Diabetes doubles the risk of developing depression [5] . Poor psychological functioning causes suffering, and can seriously interfere with daily diabetes self-management, with subsequent poor medical outcomes and high costs [6-8] . A stepped care approach, with systematic monitoring of well-being in place, can help to identify mild and serious psychological problems and offer appropriate treatment [9] . All diabetes professionals can assist patients in coping with the burden of diabetes and help resolve behavioural and psychological issue, as part of ongoing diabetes care and education. More serious psychological problems warrant referral to mental health specialists. Evidence-base Psychosocial aspects of diabetes care are included (to varying extents) in the guidelines from the Canadian [10] , SIGN [11] , NICE [12] , Australia [13] and in the American Diabetes Association (ADA) standards of care [14] . Evidence-based guidelines for psychosocial care in adults with diabetes have been published under the auspices of the German Diabetes Association (DDG), indicating the level of evidence for psychological interventions in different problem areas [15] . The need for systematic evaluation of the patient’s psychological status is underscored by the finding that depression is highly prevalent among people with diabetes but remains undiagnosed in 30-50% of the cases [16] . A systematic review and meta-analysis confirmed the efficacy of both antidepressant medication and psychological therapy in people with type 1 and type 2 diabetes and co-morbid major depression, in terms of depression and glycaemic control [17] . Largest effect sizes were reported for psychological therapies, in particular cognitive behaviour therapy [18] . An RCT showed that web-based guided self-help centred on cognitive behaviour therapy for people with type 1 and type 2 diabetes with mild to moderately severe depression is effective [19] . There is growing evidence that psychological counselling can contribute to improved adherence and psychological outcomes in people with diabetes [20] . A systematic review and meta-analysis has shown that, overall, psychological interventions are effective in improving glycaemic control in type 2 diabetes [21] .
Page 1: INTERNATIONAL DIABETES FEDERATION,
Page 4: Correspondence, and related literat
Page 7 and 8: Global Guideline for Type 2 Diabete
Page 10 and 11: Methodology The following methodolo
Page 12 and 13: GLOBAL GUIDELINE FOR TYPE 2 DIABETE
Page 14 and 15: 1 SCREENING AND DIAGNOSIS Recommend
Page 16 and 17: Evidence-base Diabetes is associate
Page 18 and 19: Implementation A clear and transpar
Page 20 and 21: 2 CARE DELIVERY Recommendations Rec
Page 22 and 23: Evidence-base Systems underlying st
Page 24 and 25: Potential indicator Indicator Denom
Page 26 and 27: 3 EDUCATION Recommendations Recomme
Page 28 and 29: The evidence from eight trials (six
Page 30 and 31: 7 Mulcahy K, Maryniuk M, Peeples M,
Page 34 and 35: Consideration People coping with di
Page 36 and 37: 18. van Bastelaar KM, Pouwer F, Cui
Page 38 and 39: Comprehensive care LS C 1 Advice on
Page 40 and 41: Implementation Recognition of the i
Page 42 and 43: 17. Banister NA, Jastrow ST, Hodges
Page 44 and 45: Glucose measurement Plasma glucose
Page 46 and 47: Consideration The assessment/interv
Page 48 and 49: 7 CLINICAL MONITORING Recommendatio
Page 50 and 51: The introduction of continuous ambu
Page 52 and 53: Evaluation There should be records
Page 54 and 55: 24. Mittman N, Desiraju B, Fazil I,
Page 56 and 57: Comprehensive care SM C 1 The princ
Page 58 and 59: Implementation Provision should be
Page 60 and 61: 9 GLUCOSE CONTROL THERAPY Recommend
Page 62 and 63: Comprehensive care GC C 1 The princ
Page 64 and 65: Outcomes studies compared with othe
Page 66 and 67: as new evidence, particularly the r
Page 68 and 69: 6. International Diabetes Federatio
Page 70 and 71: 10 BLOOD PRESSURE CONTROL Recommend
Page 72 and 73: Evidence-base The evidence-base on
Page 74 and 75: Consideration Blood pressure manage
Page 76 and 77: Anglo‐Scandinavian Cardiac Outcom
Page 78 and 79: CV9 Consider other medications for
Page 80 and 81: The Australian guidelines recommend
Page 82 and 83:
Consideration Cardiovascular risk p
Page 84 and 85:
2. Evans JMM, Wang J, Morris AD. Co
Page 86 and 87:
12 EYE SCREENING Recommendations Th
Page 88 and 89:
hormone, anti-vascular endothelial
Page 90 and 91:
diabetes population coverage. Evide
Page 92 and 93:
13 KIDNEY DAMAGE Recommendations Th
Page 94 and 95:
Evidence-base CKD is defined as a g
Page 96 and 97:
References 1. Kidney Foundation Dis
Page 98 and 99:
2. Evaluate footwear - provide appr
Page 100 and 101:
The output from these documents is
Page 102 and 103:
15 NERVE DAMAGE Recommendations Rec
Page 104 and 105:
disturbance, orthostatic hypotensio
Page 106 and 107:
16 OLDER PEOPLE Recommendations Thi
Page 108 and 109:
Limited care OPL1 The principles ar
Page 110 and 111:
Diabetes is associated with an incr
Page 112 and 113:
3. Brown AF, Mangione CM, Saliba D,
Page 114 and 115:
17 IN-PATIENT CARE Recommendations
Page 116 and 117:
Comprehensive care HO C 1 The princ
Page 118 and 119:
measurement of blood glucose is occ
Page 120 and 121:
MDRD modification of diet in renal
Page 122 and 123:
Disclaimer The IDF is not engaged i
show all

Evidence-base - International Diabetes Federation

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?