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Disclosures: Stewart reports no relevant financial disclosures.
July 15, 2020
3 min read
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Comprehensive care ‘crucial’ to reduce psychological burden of diabetes, COVID-19

Source/Disclosures
Disclosures: Stewart reports no relevant financial disclosures.
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Diabetes teams and clinics must incorporate comprehensive psychological care into any post-COVID-19 recovery plans to better serve patients who experienced disruptions in care as well as the providers who will be caring for them.

As the first wave of the COVID-19 pandemic subsides, people with diabetes are likely to constitute a large proportion of those with acute second- and third-wave care needs, and diabetes self-management may have been negatively affected by lockdown, Rose Stewart, BSc, DClinPsy, CPsychol, a principal clinical psychologist at Wrexham Young Adult Diabetes Service at Wrexham Maelor Hospital, Wales, U.K., wrote in a commentary published in Diabetic Medicine. Many diabetes services are beginning to create recovery plans to restart clinics in a modified format to mitigate risks, Stewart wrote.

“Services must incorporate psychological thinking into their recovery planning, both for the benefit of people living with diabetes and for health care professionals.”

“Services must incorporate psychological thinking into their recovery planning, both for the benefit of people living with diabetes and for health care professionals,” Stewart told Healio. “If this is neglected, the negative effects will be profound.”

Patient-specific psychological risks

The psychological risks posed by COVID-19 can be categorized into direct psychological harms, such as increased anxiety, bereavement and trauma symptoms, and indirect psychological harms, such as loss of employment and financial insecurity due to the pandemic, Stewart wrote.

“These harms are already being observed and will disproportionately affect some of the most vulnerable in society, such as people with a learning disability, people with severe mental illness, those living in deprived areas and young adults,” Stewart wrote. “Many in these vulnerable groups already have poor diabetes outcomes.”

Diabetes teams must be aware that the need for comprehensive psychological care will increase during the coming months, as will the severity of issues experienced by people with preexisting mental health conditions, which will negatively affect diabetes outcomes.

“Awareness of psychological issues and competency in basic assessment and empathic exploration of issues will become even more essential within diabetes teams,” Stewart wrote. “Close links with mental health and social care services will be crucial to reduce risks and ensure adequate support for those who are struggling.”

Stewart noted that it is also important to proactively identify individuals diagnosed with diabetes during COVID-19, who may be particularly vulnerable to increased psychological burden, and to offer them fast access to specialist psychological care to reduce the impact of any longer-term detrimental effects.

Provider psychological risks

Many health care professionals are experiencing a heavy psychological burden as they work additional hours and/or in high-risk areas during the pandemic, and some will have experienced people on their clinical caseloads becoming severely unwell or dying from COVID-19, Stewart wrote.

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“This work will have been in addition to having to deal with the personal effects of COVID-19, such as becoming infected themselves, worry about vulnerable family members, and living with the effects of lockdown,” Stewart wrote.

Diabetes teams are likely to become increasingly busy after COVID-19 subsides, so a “recovery” phase may be delayed, Stewart wrote. Leadership will play a key role in the management or exacerbation of the “psychological fallout” from COVID-19, and managers must be alert for signs that staff may be struggling mentally.

Psychological professionals can also play a key role in the support of people with diabetes and diabetes teams, both during and after the pandemic, she wrote.

“We must ensure recovery plans incorporate psychological aspects,” Stewart said in an interview. “Managers must ensure that staff have adequate opportunities for rest and support. Where there are diabetes psychologists in your area, call on them to help design your services.”

Stewart added that long-term planning must ensure that diabetes psychologists are enabled to return to their original area of work without compromising the availability of COVID-19-specific support services. Additional funding may be required to fill gaps in psychological care — both new and preexisting — and should ideally be agreed on nationally to prevent service inequalities.

“Research will be required to establish the prevalence of psychological issues once the initial threat of COVID-19 has subsided, both in people living with diabetes and health care staff,” Stewart said. “More research is required on effective psychological interventions for people with diabetes, particularly adults.”

For more information:

Rose Stewart, BSc, DClinPsy, CPsychol, can be reached at Wrexham Maelor Hospital, Croesnewydd Road, Wrexham, LL13 7TD, Wales, U.K.; email: rose.stewart@wales.nhs.uk; Twitter: @DrRoseStewart.