title: Recognition and management of psychosocial issues in diabetic neuropathy.
abstract: Although psychosocial aspects of diabetic neuropathy (DN) have received far less attention than biological aspects, research conducted over the last decade has begun to illuminate several important pathways between DN and psychosocial outcomes, including depression, anxiety, and self-management of diabetic foot ulcer (DFU)-risk. Growing body of evidence indicates that DN is a risk factor for depression predicting both the severity and increments in depression over time. Whereas painful DN contributes to depression, postural instability is the DN symptom with the strongest, cumulative effect on depression. Furthermore, depression and foot self-care, while having no impact on the development of recurrent diabetic foot ulcers (DFU), play a substantial role in incident first DFU. Patient common sense misconceptions about DFU risks and associated emotional responses play an important role in shaping foot self-care. Depression, and especially DFU-specific emotions, may be linked to DFU chronicity through biological and behavioral pathways that are at present under investigation in several ongoing trials. Integrative approaches that target psychological factors such as anxiety and depression while concurrently optimizing treatment and self-management may therefore be most powerful. Cognitive behavioral therapy-based techniques that are informed by these findings deserve investigation.
authors.affiliation: Department of Medicine, University of Manchester, Manchester, UK. Electronic address: lvileikyte@med.miami.edu.
authors.forename: Loretta
authors.initials: L
authors.lastname: Vileikyte
authors.affiliation: Ferkauf Graduate School of Psychology, Yeshiva University and Diabetes Research Center, Albert Einstein College of Medicine, Bronx, NY, USA.
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Gonzalez
mesh_terms: D001007:Anxiety / Q000175:diagnosis / Q000523:psychology* / Q000628:therapy; D015928:Cognitive Behavioral Therapy / Q000379:methods; D003863:Depression / Q000175:diagnosis / Q000523:psychology* / Q000628:therapy; D003920:Diabetes Mellitus / Q000175:diagnosis / Q000523:psychology* / Q000628:therapy; D017719:Diabetic Foot / Q000175:diagnosis / Q000523:psychology* / Q000628:therapy; D003929:Diabetic Neuropathies / Q000175:diagnosis / Q000523:psychology* / Q000628:therapy; D019468:Disease Management; D004644:Emotions; D006801:Humans; D012307:Risk Factors
keywords: Anxiety; Cognitive and emotional representations of ulcer risk; Cognitive-behavioral therapy; Depression; Foot self-care; Painful diabetic neuropathy; Postural instability