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diabetes and emotional health:a practical guide for health professionalsProviding emotional support for people with diabetes is particularly important at this time. Emma Shields, Senior Clinical Advisor at Diabetes UK, shows how the charity’s new guide can help you to address the challenge

iabetes is more than a physical health condition. Diabetes self-management is demanding

and complex. As well as a comprehensive understanding of diabetes, it requires high levels of self-efficacy, resilience and empowerment. Emotional and mental health problems – referred to as psychological problems from here on – are common among adults with diabetes (top right). They are associated with sub-optimal self-management, diabetes-related complications, reduced quality of life, and increased healthcare costs. People with diabetes and healthcare professionals alike recognise emotional health to be an important part of standard diabetes care. And given recent events, addressing emotional health is more important than ever.

In 2019, Diabetes UK released ‘Diabetes and emotional health: a practical guide for health professionals supporting adults with type 1 and type 2 diabetes’.*

The 7As modelA key feature of the guide is the 7As model. This dynamic model describes a seven-step process that can be applied flexibly in clinical practice as part of a person-centred approach.

The model consists of two phases: Identification of psychological

problems.2 Support of person with

psychological problems.

Using diabetes distress as an example, here we take a closer look at the 7As model.

AWAREThe first step in the model is to be aware that people with diabetes can experience diabetes distress, and that it can present in many ways.

Look for signs like: sub-optimal HbA1c, missed appointments, multiple life stressors, ineffective coping strategies, impaired relationships.

Be mindful that recommending changes to self-management, like more frequent blood glucose monitoring, can increase the burden of diabetes and therefore may increase diabetes distress.

Types of psychological problems in adults living with diabetes:• diabetes distress• fear of hypos• insulin fear• depression • anxiety disorders• eating problems.

ASKPeople with diabetes should be routinely asked about diabetes distress.

Try open-ended questions like: • “What is the most difficult part

of living with diabetes for you?”• “How is your diabetes getting in

the way of other things in your life right now?”

If diabetes-related concerns are raised, continue to ASSESS.

ASSESSAssess annually OR if AWARE or ASK stages indicate possible diabetes distress

Use a validated questionnaire like the Problem Areas in Diabetes (PAID) scale

If diabetes distress is not identified, but a problem remains, consider if another problem exists, eg depression.

ADVISENow you’ve identified the cause as diabetes distress, explain what diabetes distress is, acknowledging that living with diabetes can be challenging. Explain that learning about the signs and consequences will help. Offer the person a chance to ask questions.

Develop an action plan about next steps, eg, what needs to be done to reduce diabetes distress and the support they may need.

ASSIST or ASSIGNExplore the source of distress and support needed, for example diabetes education, review of their management plan or social support. Provide relevant support and information. To help

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manage the emotional aspects of diabetes, develop a plan for addressing the diabetes distress, starting with their most important issues.

People with diabetes tend to prefer for their diabetes healthcare professional to help manage the emotional impact of diabetes. But if you do not feel comfortable or equipped to do this, arrange referral to a relevant health professional to ASSIST.

ARRANGE Arrange a follow-up appointment to:• ask about the person’s progress• assess the potential need for

revising the action plan.

If you used a questionnaire such as PAID, consider using this again to assess their diabetes distress. Agree together how often reassessment would be valuable.

Be prepared to offer more support during this time – maybe through telephone reviews.

For a more detailed description of the 7As model, please refer to ‘Diabetes and emotional health: a practical guide for health professionals supporting adults with type 1 and type 2 diabetes’.

ConclusionPeople with diabetes are at higher risk of psychological problems. These can lead to poorer outcomes. People with diabetes and healthcare professionals alike recognise the importance of emotional health as part of standard care. The 7As model provides a useful framework for to identify and support psychological problems. Although in general most people will prefer to work with their diabetes healthcare professional for emotional support, there may be occasions when referral to a mental health professional is needed.

Key points• Emotional health is as important

as physical health.• Be aware that diabetes distress

is relatively common.• Use the 7As dynamic model

as part of patient-centred care.• Most people will prefer to work

with their diabetes healthcare professional for the support with emotional aspects of diabetes.

• Refer to a mental health professional for mental health problems when you feel you do not have the expertise to assist.

Further informationSupport for people with diabetes

Diabetes UK Helpline: Call: 0345 123 2399, Monday to Friday, 9am to 6pm, Email: helpline@diabetes.org.uk

Diabetes UK Support Forum www.diabetes.org.uk/up-forum

Local support group www.diabetes.org.uk/up-support-groups

Online education like Learning Zone www.diabetes.org.uk/up-learning-zone

Download our leaflets www.diabetes.org.uk/resources-s3/2019-03/0526%20Diabetes%20UK%20HCP_Distress _P3.pdf

Support for healthcare professionals

Emotional health guide www.diabetes.org.uk/up-emotion- prof-guide

Information prescriptionswww.diabetes.org.uk/up-info-prescription

NHS Language Matters https://www.england.nhs.uk/publication/language-matters-language-and-diabetes/

*This guide was originally developed by the

Australian Centre for Behavioural Research in

Diabetes (ACBRD), the National Diabetes Services

Scheme (NDSS) and Diabetes Australia in 2016.

The UK edition was produced by Diabetes UK

under a royalty-free, UK only, non-exclusive

sub-licence from Diabetes Australia.

The 7As Model

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