Psychological issues

In order to minimize the risk of diabetes complications, effective therapy for people with Type 2 diabetes involves lifestyle changes and poly-pharmacy targeting levels of blood glucose, blood pressure and blood fat. However, the strict targets set in recent guidelines are seldom achieved by the majority of people with diabetes. Barriers to effective diabetes therapy have been identified within the organization of health care and in the interaction between health-care providers and people with

The overall objective of Diabetes Attitudes, Wishes and Needs (DAWN) is to improve the psycho-social support for people with diabetes. This global Programme is led by Novo Nordisk, in partnership with the International Diabetes Federation (IDF), and an advisory panel of leading diabetes experts. The DAWN activities began with the DAWN Study in 2001. This global investigation into the affective aspects of the condition facilitated comparisons and cross-referencing between the key players in the diabetes community. The key finding was that critical gaps

The Middle East comprises countries such as Egypt, Israel, Jordan, Lebanon, the Palestinian Autonomous Territories and Syria, and contains several ethnic and religious groups. Moslem Arabs, however, are, by far, the largest population group and they form the dominant culture. Certain values belonging to this culture serve to make acceptance of diabetes nutritional therapy difficult. Nevertheless, it cannot be ignored that people with diabetes in the Middle East have to survive and try to be an accepted part of the society in which they live.

The IDF Congress has historically served as an international forum for sharing scientific advances. For the first time in Congress history, education, nutrition and the psychosocial aspects of diabetes were showcased in a specific track and addressed in a plenary lecture at the 17th IDF Congress in Mexico City. The inclusion of these themes served as a reassuring confirmation that the world's diabetes experts recognize the relevance of education and psychosocial aspects in improving diabetes outcomes.

The success of the Diabetic Counsellors in Training (CiTs) programme has not only been recognized locally but also internationally. The counsellors presented their programme at last year’s Pan Africa Congress held in Johannesburg and again at the 17th IDF Congress in Mexico City. At both congresses, their presentation received standing ovation. What is this revolutionary and dynamic movement out of Johannesburg, South Africa?

If insulin is such an effective drug, why are so many people with type 2 diabetes reluctant to take it, and sometimes really apprehensive, despite acknowledged poor outcomes on diet and oral blood glucose lowering agents? Are healthcare providers part of the problem? Is there such syndrome as Insulin Resistance (PIR)? For a better understanding of PIR, which is commonly observed as a problem in type 2 diabetes, we need to look beyond the demonstrated efficacy of insulin, and understand people’s beliefs, emotions and concerns regarding insulin treatment.

The findings of the recently-conducted DAWN study (Diabetes Attitudes, Wishes and Needs) tell us that people with diabetes who are cut off from a community of support not only manage their condition ineffectively, but also feel worse within themselves. Networks of supportive family, colleagues or friends appear to be at least as important as medication in relation to the ability of a person with diabetes to manage their condition.

Children need a healthy mother, not one with incapacitating complications, an unstable character due to the highs and lows of blood glucose levels, or who might endanger them by losing control while having a severe hypoglycaemic reaction. Children need a full-time caregiver. A responsible woman educated to take command of her diabetes can fulfil this role just as well as a woman without diabetes; sometimes even better.

We, women with diabetes have known it for as long as we have been women with diabetes: our problems associated with sexual function are a result of our moods, our sense of self, our body image, our psychological state, as well as our degree of control over our lives and our diabetes. At last the scientific literature has caught up with us.

The metabolic control of diabetes tends to deteriorate during the adolescent years, and this deterioration is more pronounced in teenage girls than boys. Efforts to achieve and maintain excellent blood glucose control are more difficult and less successful in adolescents than in adults. This suggests that the teenage years are a highly vulnerable period for girls with Type 1 diabetes, a time when the risk for the later development of diabetes-related complications may become accelerated.