During the Sunday morning symposium Preserving Mental Health across the Lifespan of Living with Diabetes (and during COVID-19), four behavioral specialists explored some of the mental and emotional challenges diabetes patients and their caregivers face at different stages of life.

The symposium can be viewed by registered meeting attendees at ADA2021.org through September 29, 2021. If you haven’t registered for the Virtual 81st Scientific Sessions, register today to access all of the valuable meeting content.

Randi Streisand, PhD, CDES, Professor and Chief, Division of Psychology & Behavioral Health, Children’s National Hospital, George Washington University School of Medicine & Health Sciences, shared data from behavioral health research and reviewed strategies and resources to promote overall well-being.

Studies have shown that almost half of parents experience depressive symptoms soon after a child is diagnosed with type 1 diabetes. Just as parents serve as role models for their children, health care providers serve as role models for parents, she said.

“We don’t want to consider the child in the exam room to be the only patient. We really need to think that the child support system is also sitting there,” Dr. Streisand said. “So, parent, grandparent, whoever is the caregiver, if they’re not doing well, it’s going to be really difficult for them to manage their child’s diabetes.”

Jessica Pierce, PhD, Research Scientist, Nemours Center for Healthcare Delivery Science, and Associate Professor, University of Central Florida College of Medicine, explained how diabetes fits into the general life challenges of adolescents and young adults (AYAs).

There are several evidence-based treatments to help adolescents with diabetes, Dr. Pierce said, and some emerging treatments for young adults. What’s missing are well-designed, evidence-based studies about key factors in the transition to adult care, in part because of the difficulty retaining young adults for well-designed prospective and longitudinal studies. Dr. Pierce discussed the Novel Tools for Longitudinal Studies on Transition in Type 1 Diabetes, which is designed to identify strategies to retain young adults in these types of studies. She also noted that mental health disorders are more common in AYAs with diabetes, as the disease intersects with all domains of development.

“It’s important to remember your own vulnerable adolescent and young adult moments. It really will enhance your empathy,” Dr. Pierce said. “Find something in the teen and young adult to appreciate, and be curious and connect with them in a genuine way.”

Maisa Feghali, MD, MSCR, Assistant Professor, Division of Maternal-Fetal Medicine, Magee Womens Hospital, University of Pittsburgh, discussed the psychosocial challenges of navigating diabetes during pregnancy. While gestational diabetes is often thought of as a milder version of type 2 diabetes, the risks that it presents in pregnancy are very significant compared to pregnancies not complicated by diabetes, she said. That includes almost a doubling of the risk of preeclampsia.

“The impact of gestational diabetes is very complex,” Dr. Feghali said. “Part of it is because of the very rushed timeline that we have between diagnosis around 28 weeks and outcome of delivery around 38 weeks. That really only gives 10 weeks after diagnosis of gestational diabetes to teach someone about diabetes and talk about lifestyle changes and blood sugar monitoring—initiating those interventions and then creating a significant impact in a short period of time.”

Dr. Feghali also discussed the care of women with pre-gestational diabetes who become pregnant. Barriers to care include a constant pressure to meet targets, which can lead to frustration and challenges when trying to follow a regimented diet. Health professionals need to provide emotional support and encouragement, and avoid the use of scare tactics to meet blood glucose levels, she said.

David G. Marrero, PhD, Director of the Center for Border Health Disparities, University of Arizona, discussed some of the mental health challenges of adults with diabetes. He advocated for a social-ecological model to better understand and integrate diabetes care. In that model, the individual operates within the context of family, friends, and small groups that are, in turn, embedded within layers of larger groups such as organizations, communities, cultures, and governments.

Dr. Marrero urged providers to be open-minded to patient choices even when those choices may not be considered best practice; to ensure that the patient receives adequate training and support for diabetes self-management; to encourage participation in community programs; and to recognize that the behaviors involved in managing or preventing diabetes are dynamic and multidimensional.

“Diabetes care requires a truly collaborative approach where patients and clinicians relate as equals,” he said. “The choices affecting the health and well-being of a person with diabetes are ultimately made by that person in the context of his or her daily life. As long as the individual has been fully supported, the consequences of these choices belong to the person, as well.”