Building Competency in Diabetes Education THE ESSENTIALS

CHANGES ACROSS THE LIFESPAN| 4-57

• Feeling unwell. • Fear of acute complications, such as hypoglycemia. • Fear of or experiencing chronic complications.

Measurement of diabetes-induced stress There has been considerable effort in the past several years to differentiate the diagnosis of depression from “diabetes distress”. Diabetes distress is disease specific and is defined as the “patients’ concerns about disease management, support and emotional burden and access to care“ (139,141,142). Although many patients may be experiencing “depressive symptoms”, they do not meet the criteria for the diagnosis of depression and they are more aptly diagnosed with anxiety related to diabetes specific problems (141,142). It has been found that coping skills training and problem-solving are more effective in treating diabetes distress and less effective in treating depression (141). Several tools have been developed to identify and quantify diabetes distress, which include the Problem Area in Diabetes (PAID-5) (141,142), Self-Care Inventory-Revised (SCI-R 2005) (143), Summary of Diabetes Self-Care Activities measure (SDSCA-6) (144) and the Diabetes Distress Scale (141,142). Also, the DAWN2 study developed several of their own instruments to capture the effect of diabetes on the lives of their participants (5). Many of these are online and can be readily administered. Stress response in diabetes A working definition of stress is a “constellation of events consisting of a stimulus (stressor) that precipitates a reaction in the brain (stress perception and processing) activating the physiological fight or flight mechanisms in the body (stress response)” (137,145). The physiological response causes the release of glucocorticoids, including cortisol, which activate the sympathetic nervous system leading to the physical and, in turn, psychosocial symptoms of anxiety. In the person with diabetes, stress may lead to either hyperglycemia or hypoglycemia (146); the release of counterregulatory hormones results in gluconeogenesis in the liver leading to elevated BG levels. The response, however, is often unpredictable. One variable is the presence of autonomic neuropathy which can mediate the stress response to varying degrees. Important factors are the duration and severity of the stress. In acute stress, the physiological responses are protective and compensatory, however, if the stress persists, metabolic control and self-management behaviours can be negatively impacted. Severe stress