When Paul Ciechanowski, MD, Res. ’97, MPH ’99, logs on to a telemedicine appointment, he often sees much more than his patients on the screen. In the background, he might glimpse an acoustic guitar propped in the corner, a ripe watermelon sitting on the counter or a beloved dog ambling across the room. These clues provide valuable context about a person’s life — and sometimes they are the key to helping patients open up.
“During a telemedicine appointment, patients reveal their world to me, and when I ask questions about that world, it breaks the ice and builds trust,” says Ciechanowski. “There’s no better way to engage with a person who’s feeling depressed, lonely or isolated.”
Ciechanowski is a UW associate professor in the Department of Psychiatry and Behavioral Sciences and a psychiatrist at the UW Medicine Diabetes Institute. Along with psychologist Alison Ward, PhD, he leads an innovative program that provides behavioral health support for patients with diabetes, a population that was hit especially hard by the COVID-19 pandemic.
The pandemic sparked an increase in demand for the program’s services and ushered in one of the biggest transformations in healthcare nationwide: the rise of telemedicine, a long-overdue revolution that has presented new opportunities for Ciechanowski and Ward to connect with patients.
The Demands of Diabetes
Life with diabetes — a chronic disease that causes a buildup of glucose (sugar) in the bloodstream — can feel like an unpredictable, high-stakes juggling act. Every day, it requires careful coordination of diet and exercise with blood-glucose tests, insulin injections or oral medications. Failure to do so can result in life-threatening illnesses, from hypoglycemia (dangerously low blood sugar) to diabetic ketoacidosis (very high blood sugar) to kidney failure.
“Diabetes is one of the most behaviorally demanding chronic diseases,” says Ward, a clinical professor in the University of Washington Department of Psychiatry and Behavioral Sciences. “People have to meet these demands on top of working, going to school or taking care of their children. It can cause a lot of stress across the lifespan.”
It’s a type of stress that Sam* is familiar with. His family’s experience with diabetes inspired him to invest in the UW Medicine Diabetes Institute, helping to establish the behavioral health program.
When Sam was a child, his father was diagnosed with Type 1 diabetes. It came as a shock: His father, an Olympic-qualified athlete then in his 30s, was healthy and fit. “The diagnosis threw my dad for a loop. The hardest part for him has been the grind — the daily minutiae that is diabetes,” says Sam. “There are no breaks from it, no vacations. The mental and emotional burden of diabetes is huge.”
According to the Centers for Disease Control and Prevention (CDC), people with diabetes are two to three times more likely to have depression and 20% more likely to experience anxiety. In any 18-month period, 33% to 55% of adults with diabetes develop diabetes distress, an emotional state where a person feels overwhelmed by the persistent pressure of managing their disease. Left untreated, these conditions can increase pain and discomfort from diabetes symptoms; lead to dangerous complications, such as higher blood-glucose levels; and worsen overall health outcomes.
For more than 40 years, Sam’s father, and his family, have largely shouldered the psychological burden of diabetes alone. The specialty clinic where his father receives care does not have mental health professionals on staff. In fact, less than 50% of accredited diabetes centers in the United States offer behavioral health services.
When Sam learned about the fledgling behavioral health program at the UW Medicine Diabetes Institute, he felt compelled to help it grow. “It’s the program I wish was available to my dad when he was diagnosed,” says Sam.
Meeting the Challenge of Self-Care
The UW Medicine Diabetes Institute has offered behavioral health care to patients with diabetes since 1997. Sam’s philanthropic investment in 2017 increased the clinical availability of providers and expanded the scope of their services.
Today, the program offers assessment, psychopharmacology and short-term, diabetes-focused psychotherapy to patients who have been referred by their primary care provider or endocrinologist. It helps people address a broad range of mental health conditions as well as behavioral and emotional issues that can interfere with effective diabetes care, including depression, anxiety, diabetes distress and eating disorders. The program also supports patients who may be navigating difficult family dynamics that are interfering with well-being and successful diabetes self-management.
“We try to understand a person’s point of view about their journey — not just with diabetes, but their life as a whole,” says Ciechanowski. “Together, we work through the barriers that are getting in the way of good self-care.”
When COVID-19 emerged, the stress and isolation of the pandemic made self-care even more challenging. Ciechanowski and Ward saw a spike in both new and existing patients seeking the behavioral health program’s services.
Telemedicine — rarely offered prior to the pandemic — became key to meeting that increased demand, especially during stay-at-home orders.
“It’s presented this wonderful opportunity to reach people who don’t live in Seattle. We can treat patients on a regular basis who live in Spokane or other parts of the state,” says Ward.
Telemedicine improves access to care for those who live locally, too. “It’s helped democratize our services. Telemedicine allows patients to access behavioral health care on their terms, at a time and in a place that’s convenient for them,” says Ciechanowski.
Looking beyond the pandemic, Ward and Ciechanowski see exciting opportunities for growth. Philanthropic support would enable them to hire more clinical staff, offer more group interventions for patients and train healthcare providers on the psychosocial needs of people with diabetes — needs that last a lifetime, as Sam and his family know well.
“If you actually want to improve life on the ground today for people with diabetes, there’s no better bang for your buck than addressing the mental health side of this disease,” says Sam.
*Pseudonym has been used to honor the donor’s request for anonymity.
Written by Meredith Bailey
Illustration: Simon Shaw