Psychological support for children with diabetes: are the guidelines being met?

The significant role of psychosocial factors in the management of type 1 diabetes in youth has been well documented. The International Society for Pediatric and Adolescent Diabetes (ISPAD) therefore published the Clinical Practice Consensus Guidelines for psychological care of young patients. However, it is unclear if and how these guidelines are being implemented. A questionnaire was created to assess implementation of the guidelines and directed to physicians through the ISPAD listserve via a web-based survey. One hundred fifty-five participants from 47 countries completed the survey. Ninety-six percent of respondents reported that they work in a team with other professionals, and 95 % of teams discuss psychological difficulties associated with diabetes management. Seventy-two percent of respondents reported having "easy access" to a mental health specialist (MHS). In 56 % of practice settings, the MHS is considered to be part of the team; 43 % participate in routine clinic visits and 26 % see all patients. Seventy percent screen for psychological problems and 57 % assess family functioning. Psychosocial or behavioral interventions addressing psychosocial and regimen adherence difficulties are offered by 79 % of teams. Psychological care is available for many children with diabetes worldwide. Yet, nearly 30 % of teams do not have access to a MHS. More training in the recognition of psychosocial problems and counseling skills is warranted. More advocacy is needed to increase availability and utilization of psychological services in routine diabetes care.