Imagine you wake up in the morning and you have this intense thirst, you feel nauseous, your head spinning, and you feel this tingling sensation in your feet. You know you haven’t taken your insulin shot, so your sugar level has gotten high and you are experiencing hyperglycemia, yet you still aren’t motivated to take your shots on time. Doctors, parents and friends might be pressuring you and nagging you to follow the routine and maintain your blood glucose levels, it’s that simple they say, but what they don’t know is, that it isn’t that easy! They are not aware of how draining it is to take daily insulin shots after every meal, they don’t know what it's like to excuse yourself before every meal and go take a shot and come back, they simply don’t understand! This is a glimpse of what it might be like in the life of a Diabetic patient.

The old age treatment and management of Type 1 Diabetes has always used insulin shots. As a Type 1 Diabetic since a young age, I know that the majority of diabetes management guidelines focus on the medical aspects of management without considering the patient’s psychological requirements. Although many people with diabetes live healthy lives, several studies, including The Diabetes Attitudes, Wishes, and Needs study, have highlighted that psychological support in Diabetes is poor, resulting in poor quality of life and decreased general well-being. It is often difficult for many to accept that they have to take drugs invariably throughout their life, resulting in low adherence to medication and self-care. Many patients are aware of what they should do, but their adherence to the recommended regimen is only partial. Knowledge alone does not determine behaviour, which could explain the rising numbers of Diabetic patients with rising HbA1c levels.

Management of Type 1 Diabetes should adopt an eclectic approach which involves both medication and psychological intervention to enhance its effectiveness. We tend to fail to recognise that the lack of adherence to timely insulin medication can be the cause of many psychological aspects such as anxiety or burnout, it can also lead to more serious mental health disorders such as eating disorders due to the effects of insulin intake. Hence, in order to effectively maintain blood sugar levels in diabetics, the health behaviour of timely adherence of insulin and checking of blood sugar levels are essential to be examined and studied to see if maybe they are lacking in that health behaviour due to some psychological domain.

Addressing psychosocial aspects like cognitive, emotional, behavioural, and social factors in treatment interventions would help overcome the psychological barriers associated with diabetes adherence and self-care; the latter being the ultimate goal of diabetes management. It is absolutely essential in examining the psychological needs of diabetic patients and emphasize the importance of diabetologists, mental health experts, and clinical psychologists in mitigating these patients’ difficulties which in turn can result in better management.

According to evidence, Diabetes and its consequences are significantly linked to psychological and psychiatric issues. Depression, poor eating habits, and hypoglycemia phobia are among them. (Kalra et al., 2018). Furthermore, patients with type 2 diabetes mellitus (T2DM) are twice as likely as healthy controls to develop comorbid depression, reducing patients’ quality of life. Diabetes patients, according to research, experience high levels of diabetes-specific emotional stress. This is linked to functional impairment, poor adherence to exercise, nutrition, and medications, and poor glycemic control. (Kalra et al., 2018).

Psychological Intervention and Glycemic Control

Some research has been conducted in examining the effectiveness of psychological interventions on glycemic control, medication adherence, and overall well-being and quality of life. However, they are mostly all trials or preliminary studies.

Research conducted on Type 2 Diabetic patients suggested that 24 week psychological interventions incorporated to the general standard medical assistance and guidance results in better metabolic parameters and a significant decrease in distress in Type 2 Diabetes. (Indelicato et al., 2018). Similarly, various forms of psychological interventions, such as motivational interviewing, empowerment, cognitive behavioural therapy, family interventions, and psychoanalytical techniques have seen to induce better glycemic control and emotional well-being. (Harvey, 2015).

Essentially through current research, it can be suggested that incorporating various psychological interventions catered to addressing the patients needs and requirements should be considered along with the standard medical care being provided currently for patients with diabetes.

Diabetes self-management is a vital step towards living a healthy and fulfilling life. However, it necessitates a significant amount of personal desire and behavioural change. Organisations such

as the Scottish Intercollegiate Guidelines Network, the National Institute of Health and Clinical Excellence, and the Institute for Clinical Systems Improvement have recognised the value of psychological therapies in diabetes care. These organisations have adopted evidence-based guidelines for diabetes psychosocial care in adults, hence we as a country, should also strive to incorporating psychological constructs and provide a more eclectic approach to treatment and management of diabetes. (Kalra et al., 2018)

This article has been authored by Zaina Asad, a FLAME alumna, and Dr. Moitrayee Das, Faculty of Psychology, FLAME University.