Depression

Providers should consider annually screening all patients with diabetes or a self-reported history of depression for depressive symptoms with age-appropriate depression screening measures, recognizing that further evaluation will be necessary for individuals who have a positive screen. Grade B
Providers should consider assessment for depression beginning at the diagnosis of complications or when there are significant changes in medical status. Grade B
Referrals for the treatment of depression should be made to mental health providers with experience using cognitive behavioral therapy, interpersonal therapy, or other evidence-based treatment approaches in conjunction with collaborative care with the patient’s diabetes treatment team. Grade A


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Anxiety disorders

Consider screening for anxiety in patients exhibiting anxiety or worries regarding diabetes complications, insulin injections or infusion, taking medications, or hypoglycemia that interfere with self-management behaviors and in those who express fear, dread, or irrational thoughts or show anxiety symptoms. Refer for treatment if anxiety is present. Grade B
People with hypoglycemic unawareness should be treated using Blood Glucose Awareness Training to help re-establish awareness of hypoglycemia and reduce fear of hypoglycemia. Grade A

Disordered eating behavior: clinical and subclinical

Providers should consider re-evaluating the treatment regimen of people with diabetes who present with symptoms of disordered eating behavior, an eating disorder, or disrupted patterns of eating. Grade B
Consider screening for disordered or disrupted eating using validated screening measures when hyperglycemia and weight loss are unexplained by self-reported behaviors related to medication dosing, meal plan, and physical activity. Grade B

Serious mental illness

Annually screen individuals who are prescribed atypical antipsychotic medications for prediabetes/diabetes. Grade B
Incorporate diabetes self-care activities into treatment goals in individuals who have diabetes and serious mental illness. Grade B

Youth and emerging adults

At diagnosis and during routine follow-up care, consider assessing psychosocial issues and family stresses that could impact diabetes management and provide appropriate referrals to mental health professionals. Grade E
Providers should consider monitoring youth and their parents about social adjustment and school performance. Grade B
Assess youth with diabetes for generic and diabetes-related stress around 7 to 8 years of age. Grade B
Providers should encourage developmentally appropriate family involvement in diabetes management tasks for children and adolescents. Grade A
Include children in consent processes as early as cognitive development indicates understanding of health consequences of behavior. Grade E
Adolescents may have time by themselves with their care providers starting at 12 years of age. Grade E
Providers should consider initiating discussions about care transition to an adolescent medicine or adult provider no later than 1 year prior to staring the transfer. Grade E
Monitor support from parents or caretakers of emerging adults with diabetes and encourage instrumental support. Grade E
Preconception counseling should be incorporated into routine diabetes for all females of childbearing potential. Grade A