Use of cognitive behavioral therapy, interpersonal therapy, and integrative cognitive therapy with adjunctive pharmacotherapy to address significant psychiatric symptoms are recognized treatment approaches in the nondiabetic population and should be provided to those with diabetes. Based on successful intervention methods, treatment can be individually or group administered by a trained professional (usually a behaviorally trained psychologist, social worker, or dietitian) who is familiar with the treatment of both DEB and diabetes (de Zwaan 2004, Pike 2004, Tantleff-Dunn 2004, Peterson 2004).
6. Interventions should target specific maladaptive behaviors (such as manipulation of insulin or medication omission) to ensure health, and should target cognitions about body image, self-esteem, autonomy, interpersonal relationships, and disease self-efficacy, particularly control of glucose and weight, depending upon symptoms reported, to improve mental health. Recommendations follow procedures used in the general population but with the addition of self-management behavior, which needs to be addressed with the diabetes care team in the context of preserving glycemic control. If metabolic derangements (severe hypoglycemia and ketoacidosis) are found to be associated with DEB, metabolic derangements must first be stabilized via medical management (ADA 2007).
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