Diabetes-Related Distress Identification and Intercollaborative Treatment at a Rural, Primary Care Clinic

The ADA found in 2018 that almost half of individuals with diabetes are not meeting diabetes goals, indicating great need for improved care. The purpose of this project was to implement the Diabetes Distress Scale (DDS) in a rural, primary care setting to screen adult patients with Diabetes Type II to improve Type II Diabetes management by identifying and reducing Diabetes-Related Distress (DRD), A1c values, and increasing the utilization of interdisciplinary care already available at the clinic. To reduce time burden on rural healthcare providers, DRD treatment was delegated to preexisting interdisciplinary services, including Diabetes Self-Management Program class, a dietician, and a behavioral health therapist. The project began with education to the clinic staff regarding DRD, American Diabetes Association recommendations regarding DDS use, and underutilized resources and support options currently available at the clinic. During implementation, clinic nurses collected DDS scales and, when positive scales were encountered, a referral algorithm was used to determine beneficial interdisciplinary care visits. Data was collected from June 1, 2019, and ceased on March 1, 2020, due to the 2019 Coronavirus pandemic. During the implementation period, increased referral rates were observed, although many patients declined the services. Of patients with initial A1c values greater than 8%, half of participants reduced A1c below 8% and the other half did not. Results were similar for decreasing DRD with half of participants reporting less at follow-up and the other half reporting the same or more. Two patients reported moderate to high levels of DRD and both experienced substantial increases in A1c values at follow up. The DDS scales facilitated excellent conversations with patients and unveiled components of unmet needs in diabetes care to assist healthcare providers in building an individualized treatment plan that utilizes interdisciplinary staff members to empower patients with self-care skills to ultimately improve their condition and quality of life