Hi-R-Ed Online

So, What Can We Do?

Encourage peer support programs:

Recognize baby steps by celebrating small victories in disease management.

Build patient-centered plans for maintenance care that do not put undue stress on the patients in order to prevent burn out, and reassess this plan regularly as life, and life stresses, change.
Make therapy changes at a pace, or in smaller stages, to minimize stress--and educate patients on the reasons for those changes.
Monitor for the patient for unhealthy coping including substance abuse, aggressive or abusive behaviors, or changes in academic performance.

Encourage peer support programs

Encourage celebration of small victories

Build patient-centered maintenance

plans

Make therapy changes at patient’s

pace or in stages

Monitor for unhealthy coping in

patient and supports

Keep a sense of humor

Self-assessment of practices

As a healthcare professional, we should routinely self assess for biases, or the use of stigmatizing language or practices.

Assessing ourselves as clinicians and our practices for signs of bias, racism, stigma, or judgment is the key to providing supportive patient care.

Language used

In range/out of range vs good/bad

Person With Diabetes vs Diabetic Patient

Biases

Assumptions based on the patient’s body type, race or age

Judgement

Putting the blame on the patient’s “Compliance” rather than on barriers or physiology

Discussing medication options as a “punishment” for failure to change lifestyle

*Are patients missing appointments because they fear judgment or shame for not meeting goals? Then how can we ever help them meet those goals?

Wildcards

There are some unknowns in diabetes management. Let's take a look at these wildcards:

CGM devices can reduce the stress of constant fingersticks and having to carry devices, but the intensity of constant data can be overwhelming and stressful.

Insulin pumps can reduce the stress of regular injections, and reduce hypoglycemia, while also allowing for more flexibility in eating and activity timing. However, wearing a device can be stressful and patients should be assessed as to whether a device with multiple complex steps for filling or wearing is appropriate--or whether a simpler device would be more appropriate even (if it means sacrificing some features). Not being able to “see” insulin delivery can also cause some patients severe anxiety.

Continuous Glucose Monitoring

Pros: more info, warning of lows, increases confidence, fewer finger sticks

Cons: overwhelming amount of data, visualization can lead to over-treatment

Insulin Pumps

Pros: flexibility of insulin delivery, lower risk of hypoglycemia, automated features can reduce management burden and diabetes interactions

Cons: wearing a device, increased financial burden, complex procedures, trusting the device

Conclusion
In the future, researchers will continue to develop new opportunities for understanding and mitigating the effects of stress on diabetes management.

There is more research and development in the diabetes management space to use Time in Range (“Time-in-Range”, or TIR, which is the percentage of time that a person spends with their blood glucose level in the target range), and other multi-faceted risk measurement scales to determine the stability of blood sugar control. These are more patient-centered measurements that portray less of a “pass/fail” mentality or stigma, and take into account the full range of wellness efforts that the patient may be making including BMI (body mass index), BP (blood pressure), A1C, Time in Range, Standard Deviation, and presence of complications. So what we see in the future may look something like this:

Evolution of Time in Range, and Risk Scoring may replace A1C as the standard of measurement

Increased awareness of differing socio-economic needs and best practices for these populations

Increased research and study into multiple systems involved in stress responses, and the impact on the complex physiology of diabetes management.