Skip to main content
SpringerLink
Log in

Working with Challenging Patients in Diabetes Treatment

  • Chapter
Educating Your Patient with Diabetes

Part of the book series: Contemporary Diabetes ((CDI))

Abstract

Patients in diabetes treatment sometimes struggle with psychosocial problems that may interact with their abilities to manage diabetes. Health care providers may feel frustrated, ineffective, and helpless because it is difficult to form a working alliance with these challenging patients. This chapter defines the working alliance and presents it as an essential ingredient of patient-centered diabetes treatment and as a salient factor in counteracting challenging patient encounters. It also reviews the literature on fear-based psychosocial problems in relation to hypoglycemia, hyperglycemia, or weight gain as well as co-morbid conditions of diabetes, depression, and other chronic illnesses. This chapter also discusses the ways these conditions contribute to challenging patient encounters and presents clinical vignettes to illustrate the dynamics and complexities of working with these psychosocial difficulties. Finally, suggestions are offered on ways to build a working alliance with patients in challenging patient encounters.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 139.00
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Rubin RR, M. P. Psychological issues and treatment for people with diabetes. J Clin Psychol 2001;57(4):457–78.

    Article  PubMed  Google Scholar 

  2. Peyrot M, Rubin RR, Lauritzen T, Snoek FJ, Matthews DR, Skovlund SE. Psychosocial problems and barriers to improved diabetes management: results of the Cross-National Diabetes Attitudes, Wishes and Needs (DAWN) Study. Diabet Med 2005;22(10):1379–85.

    Article  PubMed  CAS  Google Scholar 

  3. Kaplan SH, Greenfield S, Ware JE, Jr. Assessing the effects of physician-patient interactions on the outcomes of chronic disease. Med Care 1989;27(3 Suppl):S110–27.

    Article  PubMed  CAS  Google Scholar 

  4. Von Korff M, Gruman J, Schaefer J, Curry SJ, Wagner EH. Collaborative management of chronic illness. Ann Intern Med 1997;127(12):1097–102.

    Google Scholar 

  5. Bordin ES. The generalizability of the psychoanalytic concept of the working alliance. Psychotherapy: Theory, Res & Practice 1979;26(3):252–60.

    Article  Google Scholar 

  6. Strauss GJ. Psychological factors in intensive management of insulin-dependent diabetes mellitus. Nurs clin North Am 1996;31(4):737–45.

    PubMed  CAS  Google Scholar 

  7. Andersen RM. Revisiting the behavioral model and access to medical care: does it matter? J Health Soc Behav 1995;36(1):1–10.

    Article  PubMed  CAS  Google Scholar 

  8. Anderson RM, Funnell MM. Patient empowerment: reflections on the challenge of fostering the adoption of a new paradigm. Patient Educ Couns 2005;57(2):153–7.

    Article  PubMed  Google Scholar 

  9. Escudero-Carretero MJ, Prieto-Rodriguez MA, Fernandez-Fernandez I, March-Cerda JC. [Physician/patient relationship in diabetes mellitus type 1 treatment. A qualitative study]. Atencion primaria/Sociedad Espanola de Medicina de Familia y Comunitaria 2006;38(1): 8–15.

    PubMed  Google Scholar 

  10. Fuertes JN, Mislowack A, Bennett J, et al. The physician-patient working alliance. Patient Educ Couns 2007;66(1):29–36.

    Article  PubMed  Google Scholar 

  11. Gavin LA, Wamboldt MZ, Sorokin N, Levy SY, Wamboldt FS. Treatment alliance and its association with family functioning, adherence, and medical outcome in adolescents with severe, chronic asthma. J Pediatr Psychol 1999;24(4):355–65.

    Article  PubMed  CAS  Google Scholar 

  12. Strous RD, Ulman AM, Kotler M. The hateful patient revisited: Relevance for 21st century medicine. Eur J Intern Med 2006;17(6):387–93.

    Article  PubMed  Google Scholar 

  13. Ciechanowski PS, Katon WJ, Russo JE, Walker EA. The patient-provider relationship: attachment theory and adherence to treatment in diabetes. Am J Psychiatry 2001;158(1): 29–35.

    Article  PubMed  CAS  Google Scholar 

  14. Wens J, Vermeire E, Royen PV, Sabbe B, Denekens J. GPs’ perspectives of type 2 diabetes patients’ adherence to treatment: A qualitative analysis of barriers and solutions. BMC Fam Pract 2005;6(1):20.

    Article  PubMed  Google Scholar 

  15. Cooper-Patrick L, Gallo JJ, Gonzales JJ, et al. Race, gender, and partnership in the patient-physician relationship. Jama 1999;282(6):583–9.

    Article  PubMed  CAS  Google Scholar 

  16. Koekkoek B, van Meijel B, Hutschemaekers G. “Difficult patients” in mental health care: a review. Psychiatr Serv 2006;57(6):795–802.

    Article  PubMed  Google Scholar 

  17. Robbins JM, Beck PR, Mueller DP, Mizener DA. Therapists’ perceptions of difficult psychiatric patients. The Journal of nervous and mental disease 1988;176(8):490–7.

    Article  PubMed  CAS  Google Scholar 

  18. Macdonald M. Seeing the cage: stigma and its potential to inform the concept of the difficult patient. Clinical nurse specialist CNS 2003;17(6):305–10; quiz 11–2.

    Article  PubMed  Google Scholar 

  19. Peyrot M, Rubin RR. Levels and risks of depression and anxiety symptomatology among diabetic adults. Diabetes Care 1997;20(4):585–90.

    Article  PubMed  CAS  Google Scholar 

  20. Polonsky WH, Anderson BJ, Lohrer PA, et al. Assessment of diabetes-related distress. Diabetes Care 1995;18(6):754–60.

    Article  PubMed  CAS  Google Scholar 

  21. Welch GW, Jacobson AM, Polonsky WH. The Problem Areas in Diabetes Scale. An evaluation of its clinical utility. Diabetes Care 1997;20(5):760–6.

    Article  PubMed  CAS  Google Scholar 

  22. Ritholz MD, Jacobson AM. Living with hypoglycemia. J Gen Intern Med 1998;13(12): 799–804.

    Article  PubMed  CAS  Google Scholar 

  23. Polonsky WH, Davis CL, Jacobson AM, Anderson BJ. Correlates of hypoglycemic fear in type I and type II diabetes mellitus. Health Psychol 1992;11(3):199–202.

    Article  PubMed  CAS  Google Scholar 

  24. Boyle S, Allan C, Millar K. Cognitive-behavioural interventions in a patient with an anxiety disorder related to diabetes. Behaviour research and therapy 2004;42(3):357–66.

    Article  PubMed  Google Scholar 

  25. Green L, Feher M, Catalan J. Fears and phobias in people with diabetes. Diabetes Metab Res Rev 2000;16(4):287–93.

    Article  PubMed  CAS  Google Scholar 

  26. Clark DM. Anxiety disorders: why they persist and how to treat them. Behaviour research and therapy 1999;37 Suppl 1:S5–27.

    PubMed  Google Scholar 

  27. Cryer PE, Davis SN, Shamoon H. Hypoglycemia in diabetes. Diabetes Care 2003;26(6): 1902–12.

    Article  PubMed  CAS  Google Scholar 

  28. Cox D, Gonder-Frederick L, Polonsky W, Schlundt D, Julian D, Clarke W. A multicenter evaluation of blood glucose awareness training-II. Diabetes Care 1995;18(4):523–8.

    Article  PubMed  CAS  Google Scholar 

  29. DCCT. Weight gain associated with intensive therapy in the diabetes control and complications trial. The DCCT Research Group. Diabetes Care 1988;11(7):567–73.

    Article  Google Scholar 

  30. Hogel J, Grabert M, Sorgo W, Wudy S, Gaus W, Heinze E. Hemoglobin A1c and body mass index in children and adolescents with IDDM. An observational study from 1976–1995. Exp Clin Endocrinol Diabetes 2000;108(2):76–80.

    Article  PubMed  CAS  Google Scholar 

  31. Thompson CJ, Cummings JF, Chalmers J, Gould C, Newton RW. How have patients reacted to the implications of the DCCT? Diabetes Care 1996;19(8):876–9.

    Article  PubMed  CAS  Google Scholar 

  32. Polonsky WH, Anderson BJ, Lohrer PA, Aponte JE, Jacobson AM, Cole CF. Insulin omission in women with IDDM. Diabetes Care 1994;17(10):1178–85.

    Article  PubMed  CAS  Google Scholar 

  33. Goebel-Fabbri AE, Fikkan J, Connell A, Vangsness L, Anderson BJ. Identification and treatment of eating disorders in women with type 1 diabetes mellitus. Treat Endocrinol 2002;1(3):155–62.

    Article  PubMed  Google Scholar 

  34. Goebel-Fabbri AE, Fikkan J, Franko DL, Pearson K, Anderson BJ, Weinger K. Insulin restriction and associated morbidity and mortality in women with type 1 diabetes. Diabetes Care 2007;31(3):415–9.

    Article  PubMed  Google Scholar 

  35. Jones JM, Lawson ML, Daneman D, Olmsted MP, Rodin G. Eating disorders in adolescent females with and without type 1 diabetes: cross sectional study. BMJ 2000;320(7249): 1563–6.

    Article  PubMed  CAS  Google Scholar 

  36. Mannucci E, Rotella F, Ricca V, Moretti S, Placidi GF, Rotella CM. Eating disorders in patients with type 1 diabetes: a meta-analysis. J Endocrinol Invest 2005;28(5):417–9.

    PubMed  CAS  Google Scholar 

  37. Affenito SG, Adams CH. Are eating disorders more prevalent in females with type 1 diabetes mellitus when the impact of insulin omission is considered? Nutr Rev 2001;59(6):179–82.

    PubMed  CAS  Google Scholar 

  38. Biggs MM, Basco MR, Patterson G, Raskin P. Insulin withholding for weight control in women with diabetes. Diabetes Care 1994;17(10):1186–9.

    Article  PubMed  CAS  Google Scholar 

  39. Anderson RJ, Freedland KE, Clouse RE, Lustman PJ. The prevalence of comorbid depression in adults with diabetes: a meta-analysis. Diabetes Care 2001;24(6):1069–78.

    Article  PubMed  CAS  Google Scholar 

  40. Katon W, von Korff M, Ciechanowski P, et al. Behavioral and clinical factors associated with depression among individuals with diabetes. Diabetes Care 2004;27(4):914–20.

    Article  PubMed  Google Scholar 

  41. de Groot M, Anderson R, Freedland KE, Clouse RE, Lustman PJ. Association of depression and diabetes complications: a meta-analysis. Psychosom Med 2001;63(4):619–30.

    PubMed  Google Scholar 

  42. Black SA, Markides KS, Ray LA. Depression predicts increased incidence of adverse health outcomes in older Mexican Americans with type 2 diabetes. Diabetes Care 2003;26(10): 2822–8.

    Article  PubMed  Google Scholar 

  43. Ciechanowski PS, Katon WJ, Russo JE, Hirsch IB. The relationship of depressive symptoms to symptom reporting, self-care and glucose control in diabetes. Gen Hosp Psychiatry 2003;25(4):246–52.

    Article  PubMed  Google Scholar 

  44. Ciechanowski PS, Katon WJ, Russo JE. Depression and diabetes: impact of depressive symptoms on adherence, function, and costs. Arch Intern Med 2000;160(21):3278–85.

    Article  PubMed  CAS  Google Scholar 

  45. Lustman PJ, Anderson RJ, Freedland KE, de Groot M, Carney RM, Clouse RE. Depression and poor glycemic control: a meta-analytic review of the literature. Diabetes Care 2000;23(7):934–42.

    Article  PubMed  CAS  Google Scholar 

  46. Georgiades A, Zucker N, Friedman KE, et al. Changes in depressive symptoms and glycemic control in diabetes mellitus. Psychosom Med 2007;69(3):235–41.

    Article  PubMed  CAS  Google Scholar 

  47. Lin EH, Katon W, Von Korff M, et al. Relationship of depression and diabetes self-care, medication adherence, and preventive care. Diabetes Care 2004;27(9):2154–60.

    Article  PubMed  Google Scholar 

  48. Kinder LS, Katon WJ, Ludman E, et al. Improving depression care in patients with diabetes and multiple complications. J Gen Intern Med 2006;21(10):1036–41.

    Article  PubMed  Google Scholar 

  49. Klinkman MS. Competing demands in psychosocial care. A model for the identification and treatment of depressive disorders in primary care. Gen Hosp Psychiatry 1997;19(2): 98–111.

    Article  PubMed  CAS  Google Scholar 

  50. Rost K, Nutting P, Smith J, Coyne JC, Cooper-Patrick L, Rubenstein L. The role of competing demands in the treatment provided primary care patients with major depression. Arch Fam Med 2000;9(2):150–4.

    Article  PubMed  CAS  Google Scholar 

  51. Katon WJ. Clinical and health services relationships between major depression, depressive symptoms, and general medical illness. Biol Psychiatry 2003;54(3):216–26.

    Article  PubMed  Google Scholar 

  52. Kroenke K, Jackson JL, Chamberlin J. Depressive and anxiety disorders in patients presenting with physical complaints: clinical predictors and outcome. Am J Med 1997;103(5):339–47.

    Article  PubMed  CAS  Google Scholar 

  53. Wyshak G, Barsky A. Satisfaction with and effectiveness of medical care in relation to anxiety and depression. Patient and physician ratings compared. Gen Hosp Psychiatry 1995;17(2):108–14.

    Article  PubMed  CAS  Google Scholar 

  54. Jackson JL, Kroenke K. Difficult patient encounters in the ambulatory clinic: clinical predictors and outcomes. Arch Intern Med 1999;159(10):1069–75.

    Article  PubMed  CAS  Google Scholar 

  55. Hahn SR, Kroenke K, Spitzer RL, et al. The difficult patient: prevalence, psychopathology, and functional impairment. J Gen Intern Med 1996;11(1):1–8.

    Article  PubMed  CAS  Google Scholar 

  56. Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J. An inventory for measuring depression. Arch Gen Psychiatry 1961;4:561–71.

    PubMed  CAS  Google Scholar 

  57. Vileikyte L, Leventhal H, Gonzalez JS, et al. Diabetic peripheral neuropathy and depressive symptoms: the association revisited. Diabetes Care 2005;28(10):2378–83.

    Article  PubMed  Google Scholar 

  58. Lustman PJ, Freedland KE, Griffith LS, Clouse RE. Predicting response to cognitive behavior therapy of depression in type 2 diabetes. Gen Hosp Psychiatry 1998;20(5):302–6.

    Article  PubMed  CAS  Google Scholar 

  59. Katon WJ, Von Korff M, Lin EH, et al. The Pathways Study: a randomized trial of collaborative care in patients with diabetes and depression. Arch Gen Psychiatry 2004;61(10):1042–9.

    Article  PubMed  Google Scholar 

  60. Lustman PJ, Freedland KE, Griffith LS, Clouse RE. Fluoxetine for depression in diabetes: a randomized double-blind placebo-controlled trial. Diabetes Care 2000;23(5):618–23.

    Article  PubMed  CAS  Google Scholar 

  61. Bandura A. Self-efficacy: toward a unifying theory of behavioral change. Psychol Rev 1977;84(2):191–215.

    Article  PubMed  CAS  Google Scholar 

  62. Miller WR, Rollnick S. Motivational Interviewing Preparing People for Change. New York: The Guilford Press; 2002.

    Google Scholar 

  63. Rollnick S, Mason P, Butler C. Health Behavior Change A Guide for Practitioners. Edinburgh: Churchill Livingstone; 1999.

    Google Scholar 

  64. Rose M, Fliege H, Hildebrandt M, Schirop T, Klapp BF. The network of psychological variables in patients with diabetes and their importance for quality of life and metabolic control. Diabetes Care 2002;25(1):35–42.

    Article  PubMed  Google Scholar 

  65. Kvam SH, Lyons JS. Assessment of coping strategies, social support, and general health status in individuals with diabetes mellitus. Psychol Rep 1991;68(2):623–32.

    Article  PubMed  CAS  Google Scholar 

  66. Ritholz MD, Smaldone A, Lee J, Castillo A, Wolpert H, Weinger K. Perceptions of psychosocial factors and the insulin pump. Diabetes Care 2007;30(3):549–54.

    Article  PubMed  Google Scholar 

  67. Norris SL, Engelgau MM, Narayan KM. Effectiveness of self-management training in type 2 diabetes: a systematic review of randomized controlled trials. Diabetes Care 2001;24(3): 561–87.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Joslin Diabetes Center, Boston, MA, USA

    Marilyn D. Ritholz Ph.D

Authors
  1. Marilyn D. Ritholz Ph.D
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Joslin Diabetes Center, Boston, MA

    Katie Weinger

  2. Joslin Diabetes Center, Boston, MA

    Catherine A. Carver

Rights and permissions

Reprints and permissions

Copyright information

© 2009 Humana Press, a part of Springer Science+Business Media, LLC

About this chapter

Cite this chapter

Ritholz, M.D. (2009). Working with Challenging Patients in Diabetes Treatment. In: Weinger, K., Carver, C.A. (eds) Educating Your Patient with Diabetes. Contemporary Diabetes. Humana Press. https://doi.org/10.1007/978-1-60327-208-7_13

Download citation

  • DOI: https://doi.org/10.1007/978-1-60327-208-7_13

  • Publisher Name: Humana Press

  • Print ISBN: 978-1-60327-207-0

  • Online ISBN: 978-1-60327-208-7

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation