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Euthymia in Diabetes: Clinical Evidence and Practice-Based

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Euthymia in Diabetes: Clinical Evidence and Practice-Based Diabetes Ther https://doi.org/10.1007/s13300-019-0614-6 REVIEW Euthymia in Diabetes: Clinical Evidence and Practice- Based Opinion from an International Expert Group Sanjay Kalra . A. K. Das . M. P. Baruah . A. G. Unnikrishnan . Arundhati Dasgupta . Parag Shah . Rakesh Sahay . Rishi Shukla . Sambit Das . Mangesh Tiwaskar . G. Vijayakumar . Manoj Chawla . Fatimah Eliana . Ketut Suastika . Abbas Orabi . Aly Ahmed Abdul Rahim . Andrew Uloko . Roberta Lamptey . Nancy Ngugi . Silver Bahendeka . Abdurezak Ahmed Abdela . Fariduddin Mohammed . Mohammed Faruque Pathan . Muhammed Hafizur Rahman . Faria Afsana . Shajada Selim . Muaz Moosa . Moosa Murad . Pradeep Krishna Shreshtha . Dina Shreshtha . Mimi Giri . Wiam Hussain . Ahmed Al-Ani . Kaushik Ramaiya . Surender Singh . Syed Abbas Raza . Than Than Aye . Chaminda Garusinghe . Dimuthu Muthukuda . Muditha Weerakkody . Shyaminda Kahandawa . Charlotte Bavuma . Sundeep Ruder . Koy Vanny . Manish Khanolkar . Leszek Czupryniak Received: February 23, 2019 Ó The Author(s) 2019 ABSTRACT associated with diabetes mellitus (DM) and its management. Aim: To develop an evidence-based expert Background: Diabetes mellitus is a metabolic group opinion on various types of euthymia syndrome characterized by diverse biomedical and psychosocial features. Emotional health disturbances may lead to psychological and Enhanced Digital Features To view enhanced digital features for this article go to https://doi.org/10.6084/ psychiatric dysfunction and may negatively m9.figshare.7946273. influence glycemic control. Patients with DM P. Shah S. Kalra (&) Department of Endocrinology and Diabetes, Gujarat Department of Endocrinology, Bharti Hospital and Endocrine Centre, Ahmedabad, India BRIDE, Karnal, Haryana, India e-mail: [email protected] R. Sahay Department of Endocrinology, Osmania Medical A. K. Das College, Hyderabad, India Department of Endocrinology and Medicine, Pondicherry Institute of Medical Sciences, R. Shukla Puducherry, India Department of Endocrinology, Regency Hospital Ltd., Kanpur, India M. P. Baruah Department of Endocrinology, Excel Hospital, S. Das Guwahati, Assam, India Department of Endocrinology, Apollo Hospitals, Bhubaneswar, India A. G. Unnikrishnan Department of Endocrinology and Diabetes, M. Tiwaskar Chellaram Diabetes Institute, Pune, Maharashtra, Department of Diabetology, Shilpa Medical India Research Centre, Mumbai, India A. Dasgupta G. Vijayakumar Department of Endocrinology, Rudraksh Department of Diabetology, Apollo Hospitals, Superspecialty Care, Siliguri, India Chennai, India Diabetes Ther may experience diabetes distress (DD) associ- Results: After due discussions and extensive ated with burden of self-care, interpersonal deliberations, the expert group provided several issues, and emotional worries regarding the recommendations on implementing the con- ability to cope with the illness. Euthymia or a cept of euthymia in DM care. state of positive mental health and psychologi- Conclusions: Introduction of the concept of cal well-being should be considered a key out- euthymia in routine clinical practice is impor- come of diabetes care. Therefore, to achieve tant to improve the quality of life and coping optimal outcomes, the consideration and mea- skills in patients with DM. A timely clinical surement of psychological and psychiatric assessment of psychological and psychiatric aspects along with glycemic levels are very aspects along with patient-reported outcomes of important. A group of multidisciplinary clinical diabetes contributes to overall health and well- experts came together in an international being of affected individuals. meeting held in India to develop a workable Funding: Sanofi India. concept for euthymia in diabetes care. A mul- tidisciplinary approach was suggested to Keywords: Diabetes distress; Diabetes mellitus; enhance the clinical outcomes and facilitate Euthymia; Psychological; Stress patient-centered care. During the meeting emphasis was given to the concept of a euthy- mia model in diabetes care. This model focuses INTRODUCTION on enhancement of self-care skills in diabetic patients and preventative health awareness Diabetes mellitus (DM) has a profound impact on among diabetes care providers. Euthymia also both the physical and mental well-being of the encompasses patient–provider communication affected individual. Management of DM is mul- to aid enhancement of coping skills. tifaceted. In addition to accepting prescribed M. Chawla S. Bahendeka Department of Diabetology, Lina Diabetes Care and Department of Internal Medicine, Diabetes and Mumbai Diabetes Research Centre, Mumbai, India Endocrinology, St. Francis Hospital, Nsambya, Kampala, Uganda F. Eliana Department of Internal Medicine, Faculty of A. A. Abdela Medicine, YARSI University, Jakarta, Indonesia Department of Internal Medicine, Addis Ababa University, Addis Ababa, Ethiopia K. Suastika Indonesian Association of Endocrinology, Jakarta, F. Mohammed Indonesia Department of Endocrinology of Bangabandhu Sheikh, Mujib Medical University, Dhaka, A. Orabi Bangladesh Department of Internal Medicine, Faculty of Medicine, Zagazig University, Zagazig, Egypt Mohammed FaruquePathan Á F. Afsana Department of Endocrinology, Bangladesh Institute A. A. A. Rahim of Research and Rehabilitation for Diabetes, Department of Diabetes and Metabolism, Endocrine and Metabolic Disorders (BIRDEM), Alexandria University, Alexandria, Egypt Dhaka, Bangladesh A. Uloko M. H. Rahman Department of Medicine, Aminu Kano Teaching Department of Endocrinology, Dhaka Medical Hospital, Kano, Nigeria College and Hospital, Dhaka, Bangladesh R. Lamptey S. Selim Department of Family Medicine, Korle Bu Teaching Department of Endocrinology, Bangabandhu Hospital, University of Ghana, School of Public Sheikh Mujib Medical University, Dhaka, Health Ghana, Accra, Ghana Bangladesh N. Ngugi M. Moosa Á M. Murad Department of Internal Medicine and Diabetes, Department of internal Medicine, Indira Gandhi Kenyatta National Hospital, Nairobi, Kenya Memorial Hospital, Male´, Maldives Diabetes Ther pharmacotherapy, patients with DM have to fol- response characterized by extreme apprehension, low physician’s advice with regards to non-phar- discomfort, or dejection due to perceived inability macologic interventions focusing mainly on to cope with the challenges and demands of liv- lifestyle changes. Facing additional responsibili- ing with diabetes [3]. As DD is a common occur- ties of self-monitoring and adherence to the rence in DM patients, healthcare professionals marked readjustment in lifestyle factors entail a should identify the cause for DD and minimize its fair amount of stress [1]. Diabetes mellitus is impact on the affected person. linked to a high burden of psychiatric morbidity, The concept of euthymia is not confined whereas depression and anxiety are worsened by only to patients with diabetes; euthymia is hyperglycemia. Therefore, in DM patients, in applicable to diabetes care providers as well, as addition to the evaluation of glycemic levels, they are constantly under stress due to work measurement of distress, depression, and anxiety pressure. It is important for healthcare providers is crucial to achieve optimal outcomes. Learning to adopt preventive health strategies to achieve and maintaining self-management, coping skills, overall health and well-being. disease progression, and onset of complications Patient–provider communication constitutes may also precipitate psychological issues in most an integral part of the euthymia model in diabetes of patients with DM [2]. care. Effective communication between the Some mental health disorders, such as anxiety patient and provider is crucial to aid the motiva- and depression, are more prevalent in DM tional interview with the patient and also to pro- patients, whereas certain conditions, such as dia- mote enhancement of coping skills in the patient. betes distress (DD) and insulin distress, are very specific to the disease per se. Diabetes distress can be explained as an emotional worry that forms a METHODS part of the spectrum of patients’ feelings and experiences during the management of DM. At the international meeting, the experts Diabetes distress is defined as an emotional reviewed the available literature evidence and P. K. Shreshtha S. A. Raza Department of Internal Medicine, Tribhuwan Department of Endocrinology, Shaukat Khanum University Teaching Hospital, Kathmandu, Nepal Hospital and Research Center, Lahore, Pakistan D. Shreshtha T. T. Aye Department of Endocrinologist, Norvic Myanmar Society of Endocrinology and International Hospital Kathmandu, Kathmandu, Metabolism, Yangon, Myanmar Nepal C. Garusinghe M. Giri Department of Endocrinology, Colombo South Department of Endocrinology, Nepal Mediciti Teaching Hospital, Colombo, Sri Lanka Hospital, Kathmandu, Nepal D. Muthukuda W. Hussain Department of Endocrinology, Sri Jayawardenapura Department of Endocrinology & Diabetes, Dr Wiam General Hospital, Sri Jayawardenapure Kotte, Sri Clinic, Royal Hospital, Awali Hospital, Awali, Lanka Bahrain M. Weerakkody A. Al-Ani Department of Endocrinology, Teaching Hospital Department of Internal Medicine, Hamad Hospital, Karapitiya, Galle, Sri Lanka Doha, Qatar S. Kahandawa K. Ramaiya Department of Endocrinology, District General Department of Diabetology, Shree Hindu Mandal Hospital, Matara, Sri Lanka Hospital, Dar es Salaam, Tanzania C. Bavuma S. Singh College of Medicine and Health Science, University Department of Internal Medicine, Aster Al Raffah of Rwanda, Kigali, Rwanda Hospital, Muscat,
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