How 25 years of psychosocial research has contributed to a better understanding of the links between depression and diabetes

Abstract

This narrative review of the literature provides a summary and discussion of 25 years of research into the complex links between depression and diabetes. Systematic reviews have shown that depression occurs more frequently in people with type 1 or type 2 diabetes compared with people without diabetes. Currently, it remains unclear whether depression is also more common in people with impaired glucose metabolism or undiagnosed type 2 diabetes compared with people without diabetes. More prospective epidemiological research into the course of depression and an exploration of mechanisms in individuals with diabetes are needed. Depression in diabetes is associated with less optimal self‐care behaviours, suboptimal glycaemic control, impaired quality of life, incident micro‐ and macrovascular diseases, and elevated mortality rates. Randomized controlled trails concluded that depression in diabetes can be treated with antidepressant medication, cognitive–behavioural therapy (individual, group‐based or web‐based), mindfulness‐based cognitive therapy and stepped care. Although big strides forward have been made in the past 25 years, scientific evidence about depression in diabetes remains incomplete. Future studies should investigate mechanisms that link both conditions and test new diabetes‐specific web‐ or app‐based interventions for depression in diabetes. It is important to determine whether treatment or prevention of depression prevents future diabetes complications and lowers mortality rates.

The Management of Type 1 Diabetes in Adults. A Consensus Report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD)

“…Anxiety and depression often coexist and may partly overlap with symptoms of diabetes distress (174). Psychological distress, including mild to major depression, is a risk factor for poor self-care, hyperglycemia, complications, and excess mortality (174)(175)(176). The association between generalized anxiety and suboptimal blood glucose levels is less clear (177,178).…”

Depression Is Associated With Progression of Diabetic Nephropathy in Type 1 Diabetes

“…The mechanisms connecting depression to less favourable outcomes of diabetes are unclear but may be related to biological and behavioural factors (24). Indeed, a meta-analysis of 47 studies showed that depression is associated with less optimal diabetes self-care behaviours (6).…”

How do we recover from COVID‐19? Helping diabetes teams foresee and prepare for the psychological harms

“…Many in these vulnerable groups already have poor diabetes outcomes [6–8]. Diabetes teams will need to be mindful that the proportion of people with significant psychological needs in their clinic is likely to increase over the coming weeks and months, as is the severity of issues experienced by people with pre‐existing mental ill‐health, and these issues will impact negatively on diabetes outcomes [9]. Awareness of psychological issues, and competency in basic assessment and empathic exploration of issues will become even more essential within diabetes teams.…”