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Book review: Psychology in Diabetes Care and Practice by Dr Val Wilson

Pam Brown
Pam Brown reviews this in-depth guide to the psychological issues associated with diabetes and how they can be addressed in clinical scenarios.

Although psychology is such an important aspect of our care for people with both type 1 and type 2 diabetes, most of us have only very restricted or no access to psychological support for our patients. It can, therefore, be useful for clinicians to upskill in this area. In this journal, we have published useful resources on topics such as supporting people receiving a new diagnosis, why “Language Matters” in conversations about diabetes and obesity, and, in the previous issue, how stress impacts on glycaemia and self-management of diabetes.

This recently published textbook, authored by Dr Val Wilson, who herself has had type 1 diabetes for 45 years, provides an in-depth review and discussion around the emotional impact of a diabetes diagnosis, the two-way interaction between diabetes and depression, and the important topics of disordered eating in people with diabetes and the stigma and psychological aspects of obesity and metabolic surgery. There is also useful guidance on the behaviour theories relevant to diabetes and self-empowerment, and how to apply these in clinical scenarios.

The author flags up the paucity of other resources on psychological support, citing only the Diabetes and Emotional Health handbook published by Diabetes UK in 2019. Each chapter is illustrated with useful quotes from people with diabetes, helping clinicians better understand their perspective and bringing to life many of the concepts discussed. This is particularly useful since, in our time-pressured consultations, we may not offer people the opportunity to share how they are feeling emotionally, restricting ourselves to questions about physical symptoms.

There are some particularly useful observations; for example, that people with diabetes can feel talked about, rather than listened to, and that they often feel very separate from the team that is helping them to manage their diabetes. This is likely to have been worsened by the pandemic and the need for video and telephone consultations rather than face-to-face discussions.

Self-management is one of the most important aspects of diabetes care, since people only spend 1–2 hours per year discussing their care with their diabetes team. During the remaining 8758 hours of the year, they must make decisions alone about their care several times per day: decisions which have a major impact on their glycaemia and complications/comorbidities related to their diabetes.

The book is well referenced and covers a broad range of complications and comorbidities of both type 1 and type 2 diabetes. Reading it from cover to cover delivered many important insights and has, I hope, made me ask better questions and be more willing to explore the emotional impact of diabetes, particularly when HbA1c is rising or there is resistance to behaviour change or additional therapy. This will also be a useful resource to dip into after a challenging clinic, when hopefully it will help shift my frustration to better understanding the perspectives of people with diabetes.

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