Sugar Challenged

by Women’s Brain Health Initiative:

DIABETES & BRAIN HEALTH.

Diabetes may be treatable and manageable, but that doesn’t mean that living with a chronic disease is easy. There are constant stresses – managing medications, constant testing of blood sugar, and the unpredictability of the disease, not to mention the effect on everyday life, with possible limitations on exercise and socializing. It leads to a condition that is both common among people with the disease, and little-known among the general public: diabetes distress.

“There’s sadness. People feel angry or feel they can’t have a good time. The constant worry may cause them to notsleep well,” said Dr. Peter Selby, Clinician Scientist and Senior Medical Consultant at the Centre for Addiction and Mental Health (CAMH).

“They require counselling, support, they need help to manage it, to not lose their sense of self so they can have a good quality of life. If they don’t get help, some people feel overwhelmed, they just burn out and say I’m not going to be bothered with managing my diabetes, it’s too much,” Dr. Selby added in an interview with Mind Over Matter®.

Recognizing there are gaps in access to these kinds of supports, Brain Canada has partnered with JDRF Canada to fund research into interventions to help people with type 1 diabetes (T1D) deal with mental health concerns.

Dr. Selby and his team are working on one of three projects funded by the program. They’re bringing together experts in mental health and T1D care, Diabetes Action Canada, and, crucially, people living with the disease to develop a program aimed at young adults between the ages of 18 and 29, a group recognized to be particularly vulnerable to diabetes distress.

Sometimes they feel all their time is spent managing diabetes rather than living their lives as a young person. People don’t necessarily understand what they’re going through, they’re feeling worried, frustrated.

The project will carefully consider sex and gender differences. “One of the immediate challenges is that it is hard to engage men in the focus groups and experts in T1D tell me that their male patients struggle a lot but don’t seek help,” he said.

“So, distress affects them differently and we need more research in this space. Young women appear to report the most distress.”

His project is in the early stages, but the goal is to develop a mental health platform that is easily accessible for all, likely with an online element so that it can be available for people in need no matter where they live.

“It’s exciting that Brain Canada and JDRF see how critical this is to overall health and are working together with funding that integrates brain health with physical health.”

Accessibility is also a central goal of another project, which is headed by Dr. Tricia Tang, Associate Professor of Medicine at the University of British Columbia. She is one of the few psychologists who specializes in T1D. Dr. Tang and her colleagues designed a mobile app called TD1 REACHOUT – which they call REACHOUT – that delivers mental health support to adults with T1D living in rural and remote communities in British Columbia, where mental health supports can be difficult to find.

Given the shortage of specialists, they are recruiting people with T1D who have experienced the many emotional challenges specific to diabetes and are training them to offer peer-to-peer support.

WE MUST LEVERAGE WHAT WE HAVE, WHICH IS PEOPLE. EVEN MORE VALUABLE, THEY HAVE DIABETES THEMSELVES. IF WE TRAIN THEM IN COMMUNICATION SKILLS, DIABETES DISTRESS, EMPATHY, AND RESILIENCE, THEY CAN REALLY MAKE A HUGE DIFFERENCE.

The project builds upon a smaller pilot study that successfully provided a proof of concept. Her team is in the process of recruiting approximately 75 peer supporters and 220 participants. Some of the peer supporter candidates who have already stepped forward are people who benefited from the help they received in the pilot study.

“The great thing is that they’ve chosen to pay it forward. It’s just regular people, trained to provide emotional support,” said Dr. Tang.

Participants can access REACHOUT virtually in a variety of ways: a 24/7 chat function available at all hours and on weekends; one to one with a peer supporter of their choice; or video “huddles,” which are monthly face to face group sessions led by peer supporters.

The site includes a library of peer supporters, set up to look somewhat like a dating site, with information about the life and diabetes-related experience of each of the peers. It is moderated by a team of healthcare workers, who are available to intervene if someone is in crisis.

“What I love about this is you can choose what kind of support you need. It’s like precision medicine, but customized to the person’s psychological needs,” said Dr. Tang, adding that she appreciates the decision by Brain Canada and JDRF to support this kind of project.

“The funding is instrumental in obtaining the evidence to move forward with these types of mental health services. If we can demonstrate that REACHOUT is effective, we could replicate this across Canada.”

The third research project is being run out of the Children’s Hospital of Eastern Ontario (CHEO) and focuses on youth with type 1 diabetes aged 12-17.

“Most teens living with type 1 diabetes experience some level of diabetes distress. Diabetes distress happens when all the worry, frustration, and even burnout make it hard for people to take care of themselves and keep up with their daily insulin injections” said Dr. Marie-Eve Robinson of CHEO’s Division of Endocrinology and Metabolism.

The project is called Teaching Adolescents with Type 1 Diabetes Self-compassion (TADS). Self-compassion is a practice in which you treat yourself with kindness and understanding, acting the same way toward yourself as you would toward loved ones.

It teaches you to be kind towards yourself. It’s a skill that can be taught. That’s why we’re using it as a strategy to help kids with type 1 diabetes.

She and her team are recruiting participants from CHEO’s diabetes clinic. They will participate in weekly virtual sessions led by trained facilitators for eight weeks, learning about the concept of self-compassion through a variety of practices and exercises, such as guided meditations and comforting gestures. Researchers will measure the effect on the participants’ levels of diabetes distress as well as other issues, such as depression and their ability to control their blood sugar.

Dr. Robinson says she was moved to develop an intervention after seeing young people with T1D dealing with high levels of distress and mental health struggles, which were exacerbated during the pandemic.

“This is critical work. There’s a really big gap in providing mental health support for youth with type 1 diabetes. We don’t have enough resources on the ground to meet the needs of all these kids in distress. The support of Brain Canada and JDRF is allowing this important work to unfold. Without them, we couldn’t do it,” she said.

The funding program for the three projects is aligned with Brain Canada’s mental health research initiative, which focuses on developing and implementing effective strategies that address the diverse needs for mental health care.

“At Brain Canada, we really want to foster collaboration and bring together people and organizations that haven’t been working together historically,” said Dr. Viviane Poupon, Brain Canada President and CEO. “Solutions within and outside of the healthcare system are urgently needed to address mental health in people with type 1 diabetes.”

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