Our motivation

Earlier this year, one of my diabetic uncles passed away from complications arising from his health. He had been diagnosed 3 years ago. Although the whole family was aware of his condition, his death came as a surprise to all of us. This was because we have two other family members who have been living with diabetes for over 10 years now. As such when my uncle was diagnosed, we all figured that diabetes while a serious condition to live with, is manageable. However, a closer look at his lifestyle after being diagnosed revealed that he was battling stress and depression caused by his condition. That was the first time I found out about diabetes-related distress (DRD). It was immediately apparent that although my uncle was never officially diagnosed as having diabetes-related distress, that was what he was suffering from. Ever since then, I have been on a personal mission to raise awareness about it.

HITLAB’s world cup challenge to support diabetes care and management is a great opportunity to further this mission and to push it to a wider audience.


Diabetes is a challenging health condition to live with. It requires constant attention in its care and management. As a result, diabetes patients are almost always worrying about their condition. With this worry comes stress; and that stress can at times lead to psychological distress. This specific psychological distress is called diabetes-related distress. Diabetes-related distress refers to the emotional burden of living with and managing diabetes. It is distinct from depression and is commonly reported by people with both type 1 and type 2 diabetes (Shuttlewood and Nash, 2016). While the direction of causality is unclear, high levels of diabetes-related distress have been significantly associated with glycemic control (Polonsky et al, 1995; Welch et al, 1997; Fisher et al 2010; Strandberg et al, 2014), anxiety and depression (Fisher et al 2010; Papelbaum et al 2010), self efficacy (Kim et al, 2015), BMI, length of diabetes and complications (Karlsen and Bru, 2014) and social support (Tang et al, 2008).

What are we working on?

The problem of diabetes-related distress is the motivation behind the development of Nemo – a chatbot that focuses on the education and the spreading of awareness about diabetes-related distress and its effects. Although Nemo is being developed to cater mainly to people living with diabetes, it can be used by any other person to learn about diabetes-related distress. At it’s core, Nemo will serve as an interactive interface between the user and a repository of information.  Along with serving as a repository of information, Nemo will also be equipped with the Diabetes Distress Scale (DDS) - an instrument for the assessment of diabetes-related emotional distress (Polonsky et al, 2005). Equipped with the DDS, the chatbot can correctly assess a user’s level of emotional distress and based on that assessment, provide information geared towards alleviating the user’s current situation.

How does it work?

Nemo is being developed initially for the FB Messenger platform. And as such, users will need a Facebook account in order to use it. Once signed in, users can interact with Nemo through text (typing) or speech (speaking).

Although it is being developed as chatbot, our main goal is to eventually turn Nemo into a full-fledged standalone mobile app for the iOS and Android platforms. We hope to turn Nemo into a personal repository of information for all things diabetes.

Why Nemo?

We believe information is power; and with the right information, the necessary steps can be taken towards the fight against diabetes-related distress.

Works Cited

  1. Shuttlewood E, Nash J (2016) A solution-focused approach to diabetes-related distress. Journal of Diabetes Nursing 20: 102–7
  2. Polonsky WH, Anderson BJ, Lohrer PA et al (1995) Assessment of diabetes-related distress. Diabetes Care 18: 754–60
  3. Welch GW, Jacobson AM, Polonsky WH (1997) The Problem Areas in Diabetes Scale: An evaluation of its clinical utility. Diabetes Care 20: 760–66
  4. Fisher L, Mullan JT, Arean P et al (2010) Diabetes distress but not clinical depression or depressive symptoms is associated with glycemic control in both cross-sectional and longitudinal analyses. Diabetes Care 33: 23–8
  5. Strandberg RB, Graue M, Wentzel-Larsen T et al (2014) Relationships of diabetes-specific emotional distress, depression, anxiety, and overall well-being with HbA1c in adult persons with type 1 diabetes. J Psychosom Res 77: 174–9
  6. Papelbaum M, Lemos HM, Duchesne M et al (2010) The association between quality of life, depressive symptoms and glycemic control in a group of type 2 diabetes patients. Diabetes Res Clin Pract 89: 227–30
  7. Kim G, Shim R, Ford KL Baker TA (2015) The relation between diabetes self-efficacy and psychological distress among older adults: Do racial and ethnic differences exist? J Aging Health 27: 320 –33
  8. Karlsen B, Bru E (2014) The relationship between diabetes-related distress and clinical variables and perceived support among adults with type 2 diabetes: A prospective study. Int J Nurs Stud 51: 438–47 
  9. Tang TS, Brown MB, Funnell MM, Anderson RM (2008) Social support, quality of life, and self-care behaviors among African Americans with type 2 diabetes. Diabetes Educ 34: 266–76 
  10. William H. Polonsky, Lawrence Fisher, Jay Earles, R. James Dudl, Joel Lees, JosephMullan, Richard A. Jackson (2005) Assessing Psychological Distress in Diabetes: Development of the Diabetes Distress Scale. Diabetes Care 3: 626-631
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