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| | Clinical Depression vs. Diabetes Distress in Type 2 Diabetes Previous research has defined diabetes distress as a condition where patients become stressed about being able to manage their disease, obtaining the support they need, managing the emotional burden of diabetes, and accessing needed care. Although many clinicians now regularly screen for clinical depression in their patients with diabetes, until recently there was no easy way to screen patients for diabetes distress -- and identify areas of diabetes management where intervention would be beneficial. In the May/June 2008 issue of the Annals of Family Medicine, Dr. Fisher and his colleagues reported that they have created a brief diabetes distress screening instrument that can be used in a clinical setting. This scale builds upon a 17-item Diabetes Distress Scale that had been developed by Drs. William Polonsky and Fisher in 2007 (DDS17). To create the briefer version of the scale, Dr. Fisher and his team assessed 496 community-based patients with type 2 diabetes utilizing the 17-item Diabetes Distress Scale and six bio-behavioral measures that included: glycated hemoglobin (HbA1c); non–high-density-lipoprotein (non-HDL) cholesterol; kilocalories; percentage of calories from fat; number of fruit/vegetable servings consumed per day; physical activity as measured by the International Physical Activity Questionnaire. From this research, they created a 2-item diabetes distress screening instrument (DDS2) that asks patients to rate on a 6-point scale how each of the following are problems for them: (1) feeling overwhelmed by the demands of living with diabetes, and (2) feeling that I am often failing with my diabetes regimen. If a patient answers affirmatively to the DDS2 questions, the DDS17 can be administered to help define the content of the distress and to direct intervention. For example, clinicians and patients can identify areas where interventions might be helpful: emotional burden (feeling overwhelmed by diabetes), physician-related distress (worries about access, trust, and care), regimen related distress (concerns about diet, physical activity, medications), and interpersonal distress (not receiving understanding and appropriate support from others). Even though clinical depression remains a prevalent condition among patients with diabetes, Dr. Fisher and his colleagues continue to show that most patients with diabetes are not clinically depressed but, instead, are distressed about their diabetes and its management. They believe that depression is related to, but distinct from, diabetes distress. Fortunately for both clinicians and patients, there are new tools that can be used to help diagnose diabetes distress – and suggest appropriate interventions. | Related Items |
