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World Diabetes Day: Interaction and impact of diabetes on mental health
For World Diabetes Day on the 14th November 2018, Nisha Shahrukh - Medical Writer at Mednet Group has written an article depicting the impact diabetes has on mental health. Including a case study showing the perspective of a young person newly diagnosed with type 1 diabetes.
In the UK alone,
diabetes is thought to affect more than 4.5 million people which is more than
any other serious health condition in the UK [1]. This number is rising fast as
around 700 people are diagnosed with diabetes everyday [1]. The leading UK
charity for people affected by diabetes, Diabetes UK, found that one of the key
things patients were asking for, was more support for their emotional and
psychological health [1].
As diabetes is a
chronic, metabolic disorder, it can impact physical, social and mental health,
including the psychological well-being of patients [2]. Additionally,
psychosocial problems, which are most commonly seen in diabetic patients, can
cause serious and negative effects on patient well-being and social life, if
left unaddressed [2].
Addressing
psychosocial aspects in treatment interventions, can help patients overcome the
psychological barriers, which are associated with adherence and self-care for
diabetes [2]. Identifying and supporting patients with psychosocial problems,
early in the onset of diabetes can promote psychosocial well-being and improve patient
ability to adjust or take adequate responsibility in diabetes self-management [2].
How Diabetes Affects Mental Health
Diabetes can
affect mental health in several ways. Often, patients find it difficult to
accept that they will have to take medication, or possibly even insulin
injections on a lifelong basis, which can result in poorer treatment adherence
and diabetes self-management [3]. Research indicates that patients with
diabetes suffer from high levels of diabetes-specific emotional stress [4, 5],
which is associated with functional impairment, poor adherence to diet,
exercise and medications [6, 7, 8].
There is evidence
which indicates that diabetes and its related complications can be strongly
associated with psychological and psychiatric issues [6, 9], which can include
depression [10], poor eating habits [11] and developing a fear of hypoglycaemic
episodes [12].
All these
psychosocial problems can develop into depressive and psychological disorders
which can be associated with poor self-care behaviours, a loss of productivity
and decreased quality of life [2].
Bearing this in
mind, it is important to identify and support patients who have developed
psychosocial problems early on in their diabetes, as it can affect their
ability to make lifestyle adjustments and take adequate responsibility for
their self-care [2].
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Depression and Diabetes Distress
Depression and
diabetes distress are two of the most common mental health conditions faced by
type 2 diabetics [13]. Depression exists in one in five adult diabetics (14),
and diabetes distress affects one third of adult diabetics [15]. Diabetes
distress is distinct from depression as it is caused by the emotional burden of
managing diabetes [15]. Both conditions can overlap - a study found that 4.5%
of adult diabetics screened positive for both mental health conditions [16].
Moreover, depression and diabetes distress can increase patient risk for
mortality, poor disease management, poor quality of life, work absenteeism and
other diabetes-related complications [15, 17].
Diabetes and
depression can both increase the risk of both macrovascular complications (such
as cardiovascular diseases) [18] and microvascular complications (such as
retinopathy, neuropathy and nephropathy) [19].
Early
recognition and routine screening for these conditions, along with
evidence-based treatment approaches for depression and diabetes distress could
improve the control of HbA1c (average blood sugar levels for the last two to
three months), blood pressure and cholesterol in addition to overall patient wellbeing
and benefits in the form of medical cost savings [20, 21].
Living With Diabetes: Emotional And
Psychological Effects
Patients find
that living with diabetes can be exhausting and usually require additional
support to help them better manage their condition and protect their mental
health. Diabetes UK carried out focus groups, online surveys and events
speaking with a total of 9000 diabetics across the UK. They found that a fear
of hypoglycaemic episodes was a constant concern for type 1 diabetics [22].
Some patients reported that they felt isolated as they were managing an
invisible condition [22] and one third of patients said that they would be
interested in receiving support and counselling from a trained professional
[22].
Patients are
clearly looking for support, as statistics suggest three in five diabetic
patient experiences emotional or mental health problems, which are a direct
result of their diabetics [23]. However,
one third of diabetics have found support in self-help materials found in
books, videos and online resources [23].
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By guiding
patients to resources of support, such as self-help reading materials, online
sources or diabetic groups, patients can be enabled to take control of their
condition and improve their mental health. Many newly diagnosed patients have
difficulty in accepting and understanding their diabetes, therefore it is vital
to give them the opportunity to discuss their condition openly and guide them
to clinics or support groups who can offer not just medical support for their
diabetes, but also mental health support.
Case Study- Emma*
I was diagnosed with type 1 diabetes at
the age of 18 only 3 months after leaving home to move away for University.
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The most useful support that I had access to was a diabetic consultant I could
go to about any issues or questions as I started to adjust to life with diabetes
– I went to see her in person and she gave me her mobile number and I was able
to contact her at any point which helped a lot – questions on what food I
should avoid, how to handle exercise – anything that popped up that I wouldn’t
have thought of whilst in the hospital.
When I returned to University this stopped – as she was located back where my parents lived which was a
real shame as it was a really useful resource and someone to just talk
to. A support network like that whilst away from home would be really
useful.
![]()

Other people I have spoken
to have been given very different advice but this really did make it a lot
easier to take on board as it gave me the confidence that my life wasn’t going
to drastically change!
*Name changed for anonymity
References
1.
Diabetes
UK (2017) The Future of Diabetes [online] Available at: https://www.diabetes.org.uk/resources-s3/2017-11/1111B%20The%20future%20of%20diabetes%20report_FINAL_.pdf
[Accessed November 2018]
2.
Kalra, S., Jena, B.N. and Yeravdekar, R., 2018. Emotional and
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3.
Kalra, S., Sridhar, G.R., Balhara, Y.P.S., Sahay, R.K.,
Bantwal, G., Baruah, M.P., John, M., Unnikrishnan, A.G., Madhu, K., Verma, K.
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Lustman, P.J., Anderson, R.J., Freedland, K.E., De Groot, M.,
Carney, R.M. and Clouse, R.E., 2000. Depression and poor glycemic control: a
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Ciechanowski, P.S., Katon, W.J., Russo, J.E. and Hirsch,
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Anderson, R.J., Freedland, K.E., Clouse, R.E. and Lustman,
P.J., 2001. The prevalence of comorbid depression in adults with diabetes: a
meta-analysis. Diabetes care, 24(6), pp.1069-1078.
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Peveler, R.C., Bryden, K.S., Neil, H.A.W., Fairburn, C.G.,
Mayou, R.A., Dunger, D.B. and Turner, H.M., 2005. The relationship of
disordered eating habits and attitudes to clinical outcomes in young adult
females with type 1 diabetes. Diabetes Care, 28(1),
pp.84-88.
12.
Cox, D.J., Irvine, A., Gonder-Frederick, L., Nowacek, G. and
Butterfield, J., 1987. Fear of hypoglycemia: quantification, validation, and
utilization. Diabetes care, 10(5), pp.617-621.
13.
Owens-Gary, M.D., Zhang, X., Jawanda, S., Bullard, K.M.,
Allweiss, P. and Smith, B.D., 2018. The Importance of Addressing Depression and
Diabetes Distress in Adults with Type 2 Diabetes. Journal of General
Internal Medicine, pp.1-5.
14.
Roy, M., Sengupta, N., Sahana, P.K., Das, C., Talukdar, P.,
Baidya, A. and Goswami, S., 2018. Type 2 diabetes and influence of
diabetes-specific distress on depression. Diabetes research and
clinical practice, 143, pp.194-198.
15.
Fisher, L., Skaff, M.M., Mullan, J.T., Arean, P., Glasgow, R.
and Masharani, U., 2008. A longitudinal study of affective and anxiety
disorders, depressive affect and diabetes distress in adults with type 2
diabetes. Diabetic medicine, 25(9), pp.1096-1101.
16.
Snoek, F.J., Bremmer, M.A. and Hermanns, N., 2015. Constructs
of depression and distress in diabetes: time for an appraisal. The
Lancet Diabetes & Endocrinology, 3(6), pp.450-460.
17.
Zhang, X., Norris, S.L., Gregg, E.W., Cheng, Y.J., Beckles,
G. and Kahn, H.S., 2005. Depressive symptoms and mortality among persons with
and without diabetes. American Journal of Epidemiology, 161(7),
pp.652-660.
18.
Lin, E.H., Rutter, C.M., Katon, W., Heckbert, S.R.,
Ciechanowski, P., Oliver, M.M., Ludman, E.J., Young, B.A., Williams, L.H.,
McCulloch, D.K. and Von Korff, M., 2010. Depression and advanced complications
of diabetes: a prospective cohort study. Diabetes care, 33(2),
pp.264-269.
19.
Ascher-Svanum, H., Zagar, A., Jiang, D., Schuster, D.,
Schmitt, H., Dennehy, E.B., Kendall, D.M., Raskin, J. and Heine, R.J., 2015.
Associations between glycemic control, depressed mood, clinical depression, and
diabetes distress before and after insulin initiation: an exploratory, post hoc
analysis. Diabetes Therapy, 6(3), pp.303-316.
20.
Katon, W., Unützer, J., Fan, M.Y., Williams, J.W.,
Schoenbaum, M., Lin, E.H. and Hunkeler, E.M., 2006. Cost-effectiveness and net
benefit of enhanced treatment of depression for older adults with diabetes and
depression. Diabetes care, 29(2), pp.265-270.
21.
Young-Hyman, D., De Groot, M., Hill-Briggs, F., Gonzalez,
J.S., Hood, K. and Peyrot, M., 2016. Psychosocial care for people with
diabetes: a position statement of the American Diabetes Association. Diabetes
care, 39(12), pp.2126-2140.
22.
Diabetes
UK (2017) The Future of Diabetes [online] Available at: https://www.diabetes.org.uk/resources-s3/2017-11/1111B%20The%20future%20of%20diabetes%20report_FINAL_.pdf
[Accessed November 2018]
23.
Diabetes
UK (2017) Three In Five People With Diabetes Experience Emotional Or Mental
Health Problems [online] Available at: https://www.diabetes.org.uk/about_us/news/three-in-five-people-with-diabetes-experience-emotional-or-mental-health-problems
[Accessed November 2018]
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