title: Psychological themes that influence self-management of type 1 diabetes.
abstract: It has long been accepted that psychological factors adversely influence efforts to optimise glycaemic control. These are often unrecognised in terms of clinical assessment and therefore under reported. This essay presents an introduction to psychological issues that interact with psychiatric co-morbidities and diabetes-specific distress, and a case scenario illustrating the interconnectedness of presenting problems and themes. In the way that we cannot separate carbohydrate counting, blood glucose monitoring and insulin dose adjustment in the understanding of a presenting problem such as poor control, so we cannot separate the concurrent thoughts, feelings, and behaviours. Each of these emotional aspects are self-managed either through avoidance, or by delayed disclosure and are frequently associated with poor health outcomes. There is a requirement for the healthcare team to be sensitised to these issues and to develop styles of communication that are empathic, reflective and non judgemental. A brief outline of evidence-based psychotherapy treatments is given.
authors.affiliation: Clare Shaban, Bournemouth Diabetes and Endocrine Centre, Royal Bournemouth Hospital, BH7 7DW Bournemouth, United Kingdom.
authors.forename: Clare
authors.initials: C
authors.lastname: Shaban
keywords: Anxiety; Depression; Diabetes distress; Eating disorder; Glycaemic control; Maladaptive coping; Psychological factors; Psychotherapy