Abstract
Background: Individuals with diabetes are at increased risk of a range of mental health conditions. This connection between physical and mental health calls for further integration among healthcare professionals (Sachar et al., 2022) (2). The main established aim was to explore how the Diabetes Integrated Care Ealing (DICE) service, in West London, addresses the psychological support needs of people with diabetes. Sachar et al.’s (2019) (3) Adapted 5-level Pyramid of Psychological Needs in People with Diabetes was utilised to tailor support based on the complexity of conditions. This abstract outlines our efforts to increase accessibility to psychological support for people with diabetes, emphasising the importance of integrated care and ongoing research. The primary author is currently developing a research proposal supervised by Kings College London (KCL) to explore these issues further.
Approach: Our first adaptation was encouraging disciplines across the DICE service to work in conjunction with one another. For example, secondary care multidisciplinary meetings including diabetes specialist nurses, diabetes psychology service, and local talking therapies clinicians have been introduced. Further, social prescribing link workers offer support to service users alongside diabetes psychology, including joint supervision sessions. The diabetes psychologist continues to provide input through screening, MDT involvement, and specific interventions such as assessments of needle phobia, ensuring timely and effective care. This helps streamline referrals, improving care pathways for those with mental health conditions and type 2 diabetes. The aforementioned 5-level pyramid (3) is used as a conceptual framework to inform levels of need and appropriate input across disciplines.
The service also offers the modified X-PERT diabetes education group, facilitated by a counselling psychologist and certified X-PERT Educator. This group addresses holistic needs of participants by combining psychological techniques for managing mood difficulties with NICE-approved structured diabetes education. Participants’ pre- and post-mood screen scores and diabetes distress scores were collected, as well as blood-glucose levels.
Results: Preliminary qualitative feedback from participants suggest positive outcomes; quantitative data collection is ongoing. Disordered eating, undiagnosed PTSD, and previously undisclosed trauma appear significant for mental health difficulties and diabetes. These issues, largely unexplored in literature, highlight a need for further research. From our preliminary data, we propose using the conceptual framework of an iceberg in our poster to illustrate the ranging severity and prevalence of these underlying issues in diabetes.
Implications: This ongoing work suggests that service users appear to benefit best from an integrated healthcare approach, thus this may be a step towards better care. Further research is needed, as illustrated by the ‘iceberg’ framework to unravel complex issues not previously explored.
References:
1.Sachar A, Breslin N, Ng SM. An Integrated Care Model for Mental Health in Diabetes : Recommendations for Local Implementation by the Diabetes and Mental Health Expert Working Group in England. Diabetic Medicine. 2022 Dec 20;40(4).
2.Sachar A, Willis T, Basudev N. Mental health in diabetes: can’t afford to address the service gaps or can’t afford not to? British Journal of General Practice. 2019 Dec 26;70(690):6–7.
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