Psychological aspects in diabetes prevention trials

Abstract

Growing understanding of the pathogenetic process of insulin-dependent diabetes mellitus diabetes has favoured attempts to predict the clinical manifestation of the metabolic disorder in people at risk by some easily measurable marker or markers and, subsequently, to prevent its onset. This complicated process includes the screening procedure based on the assumption of an eventually positive finding, the detection of islet cell antibody positivity, metabolic tests for the evaluation of the actual state of energy metabolism, the categorization of the respective individual's risk to develop diabetes, the commencement of some placebo-controlled interventive measure, and finally the chance to fail to prevent the disease. Every step in this process may constitute both a threat and a severe burden to the affected individual and his/her family, eventually arousing conflicts and depression, and hopefully also attempts to deal and cope with them. The coping procedure, however, may be greatly influenced by various pre-existing primary and acquired secondary factors. Because at present prevention trials are justified only in families already exposed to this disease, the latter may depend upon the impact of diabetes in one (or more) member(s) of the family, and upon their acquired competence to cope with the various challenges it brings. On the other hand, personal characteristics, such as individual maturity, emotional stability and the integrity of one's self-image in spite of this threat, and the competence of the family to support the threatened member may be important codeterminants of the individual's response to disease prediction and preventive activities. In order to understand the impact of disease prediction and prevention on the individual better, but also to increase his coping potential by competent advice, future prevention trials should be accompanied by psychological research and competent offers of support for the affected individuals and their families.