Psychological issues and treatments for people with diabetes.

This article examines psychological issues and their treatment among people with diabetes. The paper contains two main sections, one dealing with diagnosable clinical disorders, and the other with more mundane but nevertheless important subclinical problems in living with diabetes. We review the published literature on prevalence, manifestation, consequences, and treatment of psychological disorders in persons with diabetes, primarily depression, anxiety, and eating disorders. In describing everyday problems in living with diabetes we expand our sources beyond the published literature to include our own clinical and consulting experiences as well as our unpublished qualitative research. These problems include dietary restrictions, self-monitoring of blood glucose, taking insulin injections, and lack of support from family and health care professionals. We describe methods for dealing with such problems and discuss the tension between focusing on emotional distress versus practical issues of disease management. Finally, we briefly present some potentially positive consequences of living with diabetes so that readers can be aware of the inspirational aspects of personal experience with this disease.