University of California, San Francisco, California, USA.
Behavioral Diabetes Institute, San Diego, California, USA.
Diabet Med. 2024 Dec;41(12):e15446. doi: 10.1111/dme.15446. Epub 2024 Oct 11.
Diabetes distress (DD) refers to the emotional and behavioural challenges associated with managing this demanding chronic disease over time. DD is alarmingly common and it has a significant impact on self-management behaviours and clinical outcomes. Thus, there is growing recognition that DD is a pressing problem that deserves careful attention in clinical care. Translating the application of validated DD assessment and intervention protocols from the research to the clinical setting, however, presents challenges that require a reconsideration of some common assumptions about what DD is, how prevalent it is, how it presents itself clinically, how it might best be assessed and by whom.
We employed data from six large-scale studies using five common DD measures. Using these data, we review and challenge several common assumptions about DD.
These data suggest that, because of its relative ubiquity, DD should not be viewed as a 'co-morbidity' or 'complication' of diabetes and it should not be seen as a mental health/illness 'condition'. Furthermore, we argue that DD assessment should: (1) be accepted as a standard part of comprehensive diabetes care, (2) occur regularly using broad rather than brief screening measures and (3) be addressed directly by diabetes clinicians, rather than exclusively by behavioural specialists.
The results form the basis of a series of suggestions to enhance the translation, adoption and implementation of DD knowledge derived from the research setting directly into the real world of clinical care.
糖尿病困扰（DD）是指随着时间的推移，管理这种苛刻的慢性疾病所带来的情绪和行为挑战。DD 非常普遍，它对自我管理行为和临床结果有重大影响。因此，人们越来越认识到 DD 是一个紧迫的问题，值得在临床护理中给予关注。然而，将经过验证的 DD 评估和干预方案从研究应用到临床环境中，存在一些挑战，需要重新考虑关于 DD 的一些常见假设，包括它是什么、它有多普遍、它在临床上表现如何、如何进行最佳评估以及由谁进行评估。
我们使用了五项常用 DD 测量工具的六项大型研究的数据。利用这些数据，我们回顾并挑战了关于 DD 的几个常见假设。
这些数据表明，由于其相对普遍性，DD 不应被视为糖尿病的“合并症”或“并发症”，也不应被视为心理健康/疾病“状况”。此外，我们认为 DD 评估应：（1）被接受为全面糖尿病护理的标准部分，（2）使用广泛而不是简短的筛查措施定期进行，（3）由糖尿病临床医生直接解决，而不是仅由行为专家解决。
这些结果构成了一系列建议的基础，旨在加强将从研究环境中获得的 DD 知识直接转化为临床护理实际情况的转化、采用和实施。
