Type 1 diabetes and mental health difficulties: development of an evidence-based care pathway identification tool

Abstract Type 1 diabetes is a condition requiring complex self-management and is often associated with co-morbid mental health difficulties. The presence of mental health difficulties can lead to challenges with diabetes self-management and an increased chance of secondary diabetes complications. A difficulty faced by NHS services is that people with type 1 diabetes and co-morbid mental health difficulties may present with different mental health symptomatology, ranging from purely mental health based (e.g. depression and anxiety) to distress specifically related to living with type 1 diabetes (e.g. fear of hypoglycaemia). Through completion of consultancy work in the local area we identified a need for a Diabetes Presentation Classification Tool to aid collaborative care planning and decision making. Data collected during initial assessment in an NHS Talking Therapies service were used to classify people accessing the service with type 1 diabetes into either ‘diabetes-led’ or ‘depression-anxiety-based’ presentations. The Fleiss’ kappa inter-rater reliability score for the coding of presentations was 75%. Of 120 people discharged, the majority (85.8%) were classified as depression-anxiety based, with only 8.3% classified as diabetes-led. People with diabetes-led presentations had poorest recovery rate (28.6%), aligned with guidance that the needs of these people would be best addressed by a specialist team. This tool is designed to aid professionals with triaging people with type 1 diabetes based on their appropriateness for a primary care intervention or an intervention delivered by a clinical health psychology specialist service as part of the diabetes multi-disciplinary team (MDT). Key learning aims (1) To understand the current challenges and need for clear guidelines for the triage of people with type 1 diabetes experiencing psychological difficulties. (2) To introduce the Diabetes Presentation Classification Tool and methods used to test its reliability and validity. (3) To evaluate the outcomes (recovery rates) for people with type 1 diabetes classified with different presentations who have accessed treatment in NHS Talking Therapies.