Table 4.2

Situations that warrant referral of a person with diabetes to a mental health provider for evaluation and treatment

• If self-care remains impaired in a person with diabetes distress after tailored diabetes education
• If a person has a positive screen on a validated screening tool for depressive symptoms
• In the presence of symptoms or suspicions of disordered eating behavior, an eating disorder, or disrupted patterns of eating
• If intentional omission of insulin or oral medication to cause weight loss is identified
• If a person has a positive screen for anxiety or fear of hypoglycemia
• If a serious mental illness is suspected
• In youth and families with behavioral self-care difficulties, repeated hospitalizations for diabetic ketoacidosis, or significant distress
• If a person screens positive for cognitive impairment
• Declining or impaired ability to perform diabetes self-care behaviors
• Before undergoing bariatric or metabolic surgery and after surgery if assessment reveals an ongoing need for adjustment support