Diabetes Distress

In this podcast, Lawrence Fisher, PhD, discusses his strategies for managing patients with diabetes who have diabetes distress.


  • Fisher L. Diabetes distress: an overview of prevalence, assessment and treatment. Talk presented at: Association of Diabetes Care & Education Specialists Conference; August 12-15, 2021; Virtual.

Lawrence Fisher, PhD, is a professor emeritus at the University of California, San Francisco. 



Leigh Precopio:  Hello everyone, and welcome to another installment of Podcasts360, your go-to resource for medical news and clinical updates. I’m your moderator, Leigh Precopio, with Consultant360.

For some patients, diabetes management is a continuous challenge and can take a significant toll on their mental health. Diabetes distress is common among those who are struggling to deal with their diabetes and is often associated with poor health outcomes in these individuals.

To learn more about diabetes distress and how health care practitioners can provide care for these patients, Consultant360 reached out to Lawrence Fisher, PhD, who was a professor emeritus at the University of California San Francisco.

Dr Fisher recently presented on this topic at the Association of Diabetes Care & Education Specialists (ADCES) 2021 conference. Thank you for taking the time to answer my questions today, Dr Fisher. To begin, could you give us a brief overview of your session?

Lawrence Fisher, PhD:  Yeah. There were t3 parts to the session. One was defining what diabetes distress is and talking a little bit about its prevalence and incidence in the diabetes community for both type 1 and type 2 adults. All of this focuses on adults, at least for our work. Although, there are other studies and other materials available for adolescents and parents of adolescents and children.

The second part focused on its clinical impact and implications linking with clinical outcomes as well as quality of life. The last section was how one might go about assessing diabetes distress in a clinic setting and some tips on how to take the assessment data and make use of it in an actionable way.

Leigh Precopio:  What is the current standard of care for screening patients with diabetes for diabetes distress?

Lawrence Fisher:  That is an extremely complicated question. The reason it's complicated is there is no standard of care. There are a bunch of measures out there that attempt to assess diabetes distress, but when you look at it as a screening idea, that is, "We have a patient coming in. Let's screen and find out if they're distressed." That misses the point. Everyone with diabetes has a concomitant emotional side to it.

You live with a chronic disease that's stressful. It demands a great deal of attention over time. It yields all kinds of emotional reactions, experiences, fears, worries, concerns, a whole range of things. They exist regardless of what the screening instrument tells you.

Our focus is not on just detecting diabetes distress as if it is a comorbidity or a complication but dealing with everyone with diabetes's emotional reactions and how it influences their management of the disease.. That's very different than looking at it as something that you need to screen for.

Leigh Precopio:  Do any specific risk factors such as other mental health concerns contribute to the development of diabetes distress?

Lawrence Fisher:  No. That's not the case. In fact, the prevalence of distress in type 1 or type 2 adults is about 40%, give or take a few percent on either side. That is an enormous figure. It's alarmingly high. That's when you use a screening scale or a total distress score.

When you look at the more detailed aspects of distress, about 87% of all individuals type 1 or type 2 express significant distress in 1 or more areas or sources of diabetes care and management. Basically, this is a ubiquitous phenomenon and everybody experiences it.

Asking me the question about what's the risk factors for it implies again that it is a relatively low prevalent condition around which you need to screen for and if you don't get a positive reaction from the screen you can ignore it. That's not the case.

Leigh Precopio:  What are some common pitfalls when it comes to managing diabetes distress? How can these pitfalls be avoided?

Lawrence Fisher:  The biggest pitfalls have to do with simply not addressing it. It is rarely addressed in most diabetes care. Whether we're talking about working with primary care providers, endocrinologists, diabetes educators, nutritionists, it's not something that's built into the training programs of these professions, nor is it built into the system of care around which individuals receive their care.

The biggest pitfall is simply not being aware of the issue and not bringing it up. That's the biggest problem, a lack of awareness, both on the health care professionals' part and also on the patients' part. Many people with diabetes experience marked distress around a whole range of things. Often, they think they're the only people who feel that way. They don't think it's something that needs to be brought up with their health care provider, whomever that may be. Our work has been to increase awareness of this issue, both among health care providers, but also among patients.

Leigh Precopio:  What are some clinical pearls you would give your peers for managing diabetes distress?

Lawrence Fisher:  Oh, that's a really good question. And actually it's incredibly simple. And the pearls reflect things like asking the patient you're working with some very simple open‑ended questions that will generate a conversation about how they're doing, is people living with this disease. Very simple questions like, what's it been for you living with diabetes recently? What are the things that worry you the most about your chronic disease? What are the kinds of feelings you're experiencing around it? These kinds of very general simple questions, open the door to having a discussion and bringing to the forefront the emotional side of diabetes. Why that's important is that often the emotional side of diabetes drives diabetes management. There's both a quality of life issue that needs to be addressed, as well as the implications for what people do to manage their diabetes.

Leigh Precopio:  Thank you again, Dr Fisher.

Lawrence Fisher:  Thank you for inviting me.