If self-care remains impaired in a person with DD 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