Background: Diabetes distress (DD) refers to the feelings of stress, worry, and fear related to living with diabetes, and is a commonly unrecognized experience. Although greater DD is modestly associated with higher hemoglobin A1c, DD is common even among patients with A1c at goal. Despite its prevalence, regular assessment for DD in clinical care is not standard. This study evaluates the implementation of standardized DD assessment into a routine clinic visit.
Methods: As part of a quality improvement initiative within an academic diabetes clinic, a multi-disciplinary team of endocrinologists, psychologist, and clinic administrators introduced a validated diabetes distress scale for adults with type 1 diabetes (T1-DDS) into the clinic check-in process. Patients were coached by medical assistants to complete the T1-DDS. DD scores were calculated and provided to patient and provider. Clinicians were trained to discuss DD and deliver focused counseling interventions to patients within the scheduled visit. Implementation outcomes were assessed by interview and querying the electronic health record.
Results: Surveyed providers had positive perceptions of conducting the assessment (acceptability). Clinic staff and providers believed it was feasible to incorporate DD assessment and counseling into a preexisting scheduled visit. Since inception of this program, 95% of eligible patients seen in clinic were assessed for diabetes distress. Of those assessed, 100% discussed the results with the provider. Prevalence of clinically significant DD in all patients screened was 90.4%. Even in patients with A1c less than 7.0%, 88% reported high DD. Of those with DD, 52.6% scored highest in the subcategory of powerlessness.
Conclusions: Implementation of DD assessment into routine clinical care is feasible and acceptable by providers. Even in patients with optimal glycemic control, DD is highly prevalent. Screening for DD should be incorporated into standard comprehensive diabetes care.
T. Kompala: None. P. Fu: None. A.K. Folick: None. M. Babey: None. E. Koh: None. P. Mehta: None. L. Fisher: None. U. Masharani: None. A.B. Neinstein: Consultant; Self; Steady Health.