Integration of Clinical Psychology in the Comprehensive Diabetes Care Team

Psychosocial issues may exert substantial influence on glycemic control in diabetic patients.1-4 Psychological factors have been shown to increase the risks of poor glycemic control, “brittle diabetes,” and diabetic ketoacidosis. Depression has been identified as one negative influence of glycemic control among pediatric and adolescent patients.5 It has been cited as a possible contributing factor to sexual dysfunction in women with type 1 diabetes.6 And, depression has been observed to affect family members of patients with type 2 diabetes and may influence family dynamics toward the condition.7This growing body of literature suggests that the inclusion of a clinical psychology component in the integrated diabetes care team is desirable. Psychological factors may significantly influence glycemic control.8,9 Indeed, the Education Recognition Program of the American Diabetes Association advocates this inclusion.10However, the practical issues involved in such integration can be challenging. Problems in obtaining reimbursement for these services within a medical organization are one important set of obstacles. Psychological services are usually paid by insurers according to insurance codes and diagnostic groups (American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders codes) that differ from medical codes and diagnoses. These reimbursement patterns are often associated with distinct contractual arrangements from insurance contracts with medial care professionals. Therefore, psychological personnel and medical personnel are usually employed by different corporate entities. Thus, the actual degree to which clinical psychologists or other professional psychosocial professionals have been truly integrated into the multi-disciplinary diabetes care team is minimal.Specialty programs of diabetes care may have a higher prevalence of patients who are referred for poor glycemic control and who have significant psychosocial problems.11 The need for integrated psychosocial support services in such programs is substantial. Our diabetes …