Targeting Diabetes Distress: The Missing Piece of the Successful Type 1 Diabetes Management Puzzle.

Type 1 diabetes remains an incurable lifelong condition. It is also a disorder that impinges relentlessly, and often unpredictably, on patients’ lives, every hour of every day. Insulin requirements and glucose profiles may vary on a day-to-day basis depending on many factors. Therefore, type 1 diabetes therapy must be reviewed and adjusted frequently to achieve and maintain acceptable long-term glucose control. Given the complexity of the condition, it is not surprising that living and coping with type 1 diabetes require patients’ lifelong commitment and personal responsibility for health and behaviors. Yet, despite the best of intentions and notwithstanding advances in diabetes treatments and the generally high quality of diabetes care, the majority of patients with type 1 diabetes are not reaching glycemic targets (A1C < 7% based on the Diabetes Control and Complications Trial [DCCT] of type 1 diabetes).1,2 In the DCCT, 44.3% of intensively treated patients and only 4.3% of those in the conventional treatment group had a mean A1C value ≤ 7%.1 Calvert et al.2 reported that the median proportion of people with type 1 diabetes achieving an A1C of ≤ 7.5% in the United Kingdom was 25.8% (interquartile range 20.0–32.5%). Although flexible insulin regimens offer patients a greater chance of meeting treatment targets, these regimens also place significantly more demands on patients. Importantly, many adults with type 1 diabetes experience psychological difficulties associated with their disease3,4 that often are unrecognized, unaddressed, or mismanaged and that hinder patients from better adhering to multiple self-care tasks and achieving adequate glucose control.5,6 The clinical importance of addressing psychological distress related to type 1 diabetes with its consequences as a serious health issue is highlighted by the recognition that type 1 diabetes is a contributing factor to both depression and distress in the majority of adults with the disease.6 Practical recommendations for addressing and mitigating elevated type 1 diabetes–related distress in adult patients are scarce.7–10 This article aims to increase awareness and understanding of type 1 diabetes–related distress and to assist diabetes health care professionals by proposing therapies to prevent and mitigate it. The proposed recommendations and caveats are based on relevant evidence, including existing guidelines for type 1 diabetes management, previous reports, and the authors’ professional experience and personal insight. The ultimate goal is to optimize patient outcomes and stimulate further exploration of the best ways to practically apply the proposed concepts to improve type 1 diabetes care.