Psychosocial Support in the Healthcare Team

While type 1 diabetes requires self-management with family backing, professional support is generally delivered by a healthcare team. Members have specific expertise and roles for various aspects of diabetes management: the diabetologist (paediatrician and or physician) is usually the team director and is responsible for overall delivery of care and specific health concerns; a specialist nurse often supplies day to day diabetes care advice and the delivery of the post-diagnosis education programme; a dietician is usually available to supply information about diet and diabetes.

Working together to provide support
The healthcare team works together to inform, advise and support the patient and their family, not only in times of acute emergency (e.g. ‘hypos’ or periods of illness) but also at times of difficulty when coping with the everyday practical aspects of diabetes management. Many healthcare teams provide ‘after hours’ advice, and some countries have even incorporated this service into their national diabetes programmes. Most teams work with systems of good practice (such as the ISPAD Guidelines) or their own national clinical guidelines developed with patient and family involvement.

Invaluable standards of care
Many countries cannot supply the diverse number of professionals needed to support a team approach to care, and for many young people with diabetes, all advice comes through a single physician. Standards of care, such as the ISPAD Guidelines, are invaluable to the ‘single-handed’ team and new websites provide up-to-date information for patients that can be used to work with their physician. Many teams recognise difficulties in diabetes self-management and the resulting psychological issues: stress, anxiety, and depression. For most, these are reactive difficulties requiring simple professional support and advice.

Psychological issues
It is well documented that psychological difficulties that develop in type 1 diabetes can be considerable and may require special help from professionals such as a clinical psychologist, who is often an ‘extra’ member of the healthcare team. Their health psychology expertise and a working understanding of clinical diabetes make them ideally suited to help the relatively small number of families that experience severe problems in coping with type 1 diabetes.

Delivering support through modern technology
In future, daily support may be delivered in more novel technical ways using modern communication technology. The ubiquitous use of mobile phones (even in developing countries) and digital communication technology make “social support networks” for diabetes based around SMS and MMS systems very attractive. This development is set to expand in the next decade and will likely become a major part of healthcare team practice.

Stephen Greene