Treatment pathways for patients with uncontrolled diabetes and probable diabetes distress

Diabetes distress (DD) has a major impact on both diabetes control and emotional well-being but is mis- and underdiagnosed and undertreated. Treatment often starts with behavioral health (BH) through counseling or medications; in some patients, Certified Diabetes Care and Education Specialists (CDCES) are proven to better manage treatment burden and address distress. We performed an observational study comparing outcomes for people with high emotional distress (PHQ9 or GAD7 > 10) and high A1c 8.0 at baseline with CDCES support, BH treatment, both or neither. Results demonstrate both CDCES and behavioral health treatment were most effective (A1c -1.2%, PHQ -3.1) but received in only 4.3% of patients, while 50% of patients received BH treatment alone. Conclusion is that these services remain valuable in routine practice but are underutilized. Workflows that assist in CDCES treatment for patients at risk could improve outcomes.