Psychosocial Care and Social Determinants of Health Flashcards

A patient says they feel overwhelmed and burned out by the daily demands of diabetes self-management but do not meet criteria for major depression. This is best described as what?

Answer: Diabetes distress

Diabetes distress is the emotional burden of living with and managing diabetes. It is distinct from clinical depression and is assessed with tools such as the PAID scale or the Diabetes Distress Scale. Management includes support and DSMES.

Which tool is commonly used to screen people with diabetes for depression?

Answer: PHQ-9

The Patient Health Questionnaire (PHQ-2, followed by the PHQ-9 if positive) is widely used to screen for depression. The CAGE screens for alcohol use and the MoCA screens for cognition.

A teenager with type 1 diabetes admits to skipping insulin doses in order to lose weight. What is the most appropriate response?

Answer: Recognize it as disordered eating and coordinate referral to mental health and eating-disorder specialists

Deliberate insulin omission for weight control is a form of disordered eating that raises the risk of DKA and complications. Screening, a nonjudgmental approach and an interdisciplinary referral are the standard of care.

A patient is rationing insulin because of cost. What is the best first step?

Answer: Assess cost barriers and connect them to assistance programs, lower-cost insulin options and community resources

Cost-related nonadherence is a social determinant of health issue. Clinicians should explore the barrier nonjudgmentally and use manufacturer programs, lower-cost formulations and social work or community resources.

Which approach is recommended for screening for food insecurity in people with diabetes?

Answer: Use a validated brief screener, such as the two-item Hunger Vital Sign

ADA recommends screening for food insecurity and other social determinants of health. The two-item Hunger Vital Sign is a brief validated tool, and results should guide the meal plan, medication choices and referrals.

A patient with a history of severe hypoglycemia keeps glucose levels intentionally high and avoids their insulin dose out of fear. What approach is most appropriate?

Answer: Address fear of hypoglycemia with education, review of safety plans, and consider CGM with alarms and individualized targets

Fear of hypoglycemia can drive risky high-glucose behavior. Effective care combines empathy, structured education, a safety plan, glucagon availability, and technology such as CGM with low-glucose alerts. Targets may also be individualized.