Diabetes is a unique and complex disease and the individual living with diabetes is solely responsible for daily diabetes management.
The added stress of this responsibility significantly increases their risk for depression and anxiety.
Research has indicated that symptoms of depression have been shown to be associated with worsened blood glucose levels and increased diabetes-related complications. Therefore, diabetes prevention programs and increased awareness, screening and care for the mental health aspects of diabetes are key components in improving the quality of life for people with diabetes.
Symposia presentations at the ADA focused on the correlation between mental health and diabetes and on diabetes prevention initiatives.
A bidirectional relationship exists between diabetes and mental health.
Recommendations are more appropriate psychosocial care for people with diabetes, indicate health care providers should be trained to screen actively for and identify signs of mental health disorders and diabetes distress, as well as be more prepared to direct patients to appropriate care. Use the resource of psychologist.
“A need exists for comprehensive care for people with diabetes that addresses both their physical and mental health,” said Mary Beth Weber, PhD, MPH, assistant professor of Global Health and Epidemiology at Emory University’s Rollins School of Public Health.
“Because mental health disorders are a risk factor for diabetes and occur more frequently among people with diabetes, patients should be empowered to adopt health-promoting behaviors; be educated in diabetes self-management; taught self-efficacy for decision making and be directed to counseling and/or medications as needed. Effective, combined management of diabetes and mental health disorders is vital to improving overall health outcomes for people with diabetes.”
Weber also notes some medicines used for mental health conditions may increase diabetes risk and diabetes risk factors, such as weight gain and increased body fat, and recommends that physicians select anti-psychotic medications with a lower risk of diabetes risk factors.
Additionally, 18-45 percent of people with diabetes have diabetes distress, a state of emotional distress stemming from coping with the demands of diabetes and diabetes management. People with both diabetes and mental illness, or those who report having diabetes distress, often fare worse than other people with diabetes alone, reporting worse health status, poorer glycemic control and more risk factors, such as smoking and physical inactivity, that can worsen their health.
“Coordinated diabetes care must be practiced to properly address the needs of individuals with both diabetes and mental health disorders,” said Weber.
“Coordinated care for people with diabetes and mental health disorders, possibly with the assistance of care coordinators, could be a potential solution.
Physicians providing care to patients with diabetes must be aware of existing tools for screening for mental health disorders and diabetes distress and be knowledgeable about local resources for screening and care. Finally, diabetes prevention efforts are needed targeting individuals with mental health disorders.”
Research Perspective of Diabetes and Depression—The Neuroendocrine Link
People with diabetes are twice as likely to have depression as people without diabetes. Sherita Hill Golden, MD, the Hugh P. McCormick Family Professor of Endocrinology and Metabolism and Executive Vice-Chair of the Department of Medicine at the Johns Hopkins University School of Medicine, discussed the connection between diabetes and depression.
According to Dr. Golden, researchers now understand that the relationship between depression and diabetes is reciprocal in that people with T2D are more likely to develop depression over time, and people with depression are more likely to develop T2D.
“Clinicians across multiple disciplines should routinely screen type 1 and 2 diabetes patients with depression for diabetes and inversely screen patients with diabetes for depression,” said Dr. Golden.
“Addressing and treating both conditions together may have a beneficial effect on stress hormones and will be the subject of future ongoing research.”
Dr. Golden has done research in the Multi-Ethnic Study of Atherosclerosis (MESA), a medical research study involving more than 6,000 men and women from six communities in the U.S. that is sponsored by the National Heart Lung and Blood Institute of the National Institutes of Health. Study participants are seen at clinics in six different states, including one site at Johns Hopkins University.
In the MESA study, Dr. Golden has found that people with T2D had a 50 percent higher risk of developing depression over three years, compared to those without T2D, even after factoring in obesity markers of diabetes severity and other risk factors for depression.
Research also demonstrated that people with depression had a 21 percent higher risk of developing T2D over three years, which was only partially explained by obesity, poor health behaviors and elevated inflammation.
Dr. Golden discussed how depression and diabetes share a common abnormal stress hormone profile. One potential explanation for the higher risk of T2D in those with depression that was not explored in the original study was the role of the body’s stress hormones—cortisol and adrenaline. Abnormal patterns of stress hormones represent one of several shared mechanisms linking T2D and depression.
“If researchers can identify and intervene on these shared risk factors, then medical professionals can develop new ways to prevent and treat both conditions simultaneously,” said Dr. Golden.
“A better understanding of the biological links between T2D and depression will open the door to developing new drug interventions that target these mechanisms. That will allow us to develop new ways to prevent and treat both T2D and depression and complement existing successful behavior
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