Diabetes and Mental Health

Abstract

The experience of living with diabetes is often associated with concerns specific to the illness and can cause conditions, such as diabetes distress, psychological insulin resistance and the persistent fear of hypoglycemic episodes.• A wide range of psychiatric disorders, including major depressive disorder, bipolar and related disorders, schizophrenia spectrum and other psychotic disorders, anxiety disorders, sleep disorders, eating disorders and stress-related disorders are more prevalent in people with diabetes compared to the general population.• People living with diabetes and depressive disorders are at increased risk for earlier all-cause mortality compared to people living with diabetes without a history of depression.• All individuals with diabetes should be regularly screened for the presence of diabetes distress, as well as symptoms of common psychiatric disorders.• Compared to those with diabetes only, individuals with diabetes and mental health concerns have decreased participation in diabetes self-care, a decreased quality of life, increased functional impairment, increased risk of complications associated with diabetes, and increased health-care costs.• Cognitive behaviour therapy, patient-centred approaches (e.g. motivational interviewing), stress management, coping skills training, family therapy and collaborative case management should be incorporated into primary care. Self-management skills, educational interventions that facilitate adaptation to diabetes, addressing co-occurring mental health issues, reducing diabetes-related distress, fear of hypoglycemia, and psychological insulin resistance are all helpful.• Individuals taking psychiatric medications, particularly (but not limited to) atypical antipsychotics, benefit from regular screening of metabolic parameters to identify glucose dysregulation, dyslipidemia and weight gain throughout the course of the illness so that appropriate interventions can be instituted. KEY MESSAGES FOR PEOPLE WITH DIABETES• Living with diabetes can be burdensome and anxiety provoking, with the constant demands taking a psychological toll. As a result, many people experience distress, decreased mood and disabling levels of anxiety. Diabetes is often associated with a significant emotional burden, distress over the self-care regimen and stress in relationships (with family and friends, as well as health-care providers).• It is important to recognize your emotions and talk to your friends, family and members of your diabetes health-care team about how you are feeling. Your team can help you to learn effective coping skills and direct you to support services that can make a difference for you.• Mood and anxiety disorders are particularly common in people with diabetes. Eating, sleeping and stress-related disorders are also common. Speak to your health-care providers about any concerns you have if you think you may be developing any of these problems.• Mental health disorders can affect your ability to cope with and care for your diabetes. In view of this, it is jus...

Diabetes-Related Distress and Associated Characteristics in Patients With Type 2 Diabetes in an Urban Primary Care Setting in Greece

“…Besides, “psychological insulin resistance”, when adding insulin to a regimen, and “fear of hypoglycaemia”, are also two well-documented psychological effects in adults with diabetes. 39 …”

5. Facilitating Behavior Change and Well-being to Improve Health Outcomes:Standards of Medical Care in Diabetes—2020

“…Psychological and social problems can impair the individual's (11,(197)(198)(199)(200)(201) or family's (200) ability to carry out diabetes care tasks and therefore potentially compromise health status. There are opportunities for the clinician to routinely assess psychosocial status in a timely and efficient manner for referral to appropriate services (202,203). A systematic review and metaanalysis showed that psychosocial interventions modestly but significantly improved A1C (standardized mean difference -0.29%) and mental health outcomes (204).…”

Perceptions and experiences of living with coexisting type 2 diabetes and severe mental illness: a scoping review

“…Few studies have examined the daily life of people with both conditions, including their illness management and treatment practices. Moreover, most research into diabetes and mental illness has focused on both type 1 and type 2 diabetes and common mental disorders, such as depression, rather than on the study of type 2 diabetes or severe mental illness specifically [17,18]. However, treatments and effective self-management practices for type 1 and type 2 diabetes differ in many aspects [19,20].…”