Shine a Light on Diabetes and Mental Health

Appropriate screening tools can help identify individuals at increased risk for or with anxiety, depression and eating disorders.

Individuals with diabetes are at increased risk of anxiety, depression, and eating disorders.1

Additionally, diabetes can lead to mental health issues related to diabetes distress.2 Mental health issues may be barriers to diabetes self-management and may increase the risk of both long- and short-term complications of diabetes.1

Despite the profound impact mental health issues can have on diabetes care, only about a third of people with diabetes are diagnosed and treated.1 Without the appropriate, timely identification and management of comorbid mental health issues, a patient’s health and financial well-being can be significantly affected. It can come at a significant cost to the health care system, too.

Worry

The lifetime prevalence of generalized anxiety disorder in individuals with diabetes is approximately 20%.3 Concerns about disease complications and progression, failure to achieve glucose goals, fear of hyperglycemia or hypoglycemia, lack of awareness of hypoglycemia, and administration of insulin are commonly reported.4,5 Pre-existing fears of needles and blood may worsen with a diabetes diagnosis and may lead to severe anxiety or panic disorder.1 In addition, individuals who exhibit excessive diabetes self-management behaviors may have obsessive-compulsive disorder.6

Fear of hyperglycemia or lack of awareness of hypoglycemia may force some patients to intentionally maintain blood glucose levels above targets. Parents of children with type 1 diabetes (T1D) may also encourage this practice because of the same fear.1 Moreover, symptoms of hypoglycemia, such as heart palpitations, sweating, and tremors, can mimic symptoms of anxiety disorders, making it difficult for people with anxiety and diabetes to tell the difference.

depression

Having type 2 diabetes (T2D) increases the risk of major depressive disorder (MDD), and having type 2 diabetes increases the risk of type 2 diabetes, suggesting that they may have a two-way relationship.1 Antidepressants and psychotherapy for depression in individuals with diabetes have shown minimal effects on glycemic management and moderate effects on depression. The collaborative care model, a primary care model that integrates behavioral health and general medicine, has shown significant positive effects on both depression and glycemic management.1.7

eating disorders

Women with T1D infection have a double risk of developing an eating disorder.1 Eating disorders, such as binge eating and calorie elimination with insulin restriction, can be seen in 31% to 40% of women with diabetes aged 15-30 years.1,8 Morbid diabetes and eating disorders increase the risks of poor glycemic management, hospitalization, neuropathy, retinopathy, and premature death.1

diabetes

Diabetes stressors are significant psychological stressors resulting from the emotional burden of managing a chronic, progressive illness without any “days off”.1.9 During any 18-month period, approximately 38% to 48% of people with diabetes will experience diabetes distress.10 High levels of diabetes distress can negatively affect diabetes management and quality of life, resulting in poor dietary and exercise behaviors and medication adherence as well as poor glycemic management.9,10 Behavioral and socio-cognitive problem-solving approaches and self-compassion programs have been shown to reduce diabetes distress.11

Side note

Recipients of metabolic surgery may be at increased risk of anxiety, depression, development or worsening of substance abuse and suicidal ideation. Physicians and patients should address significant underlying mental health conditions before considering surgery.12-14 After metabolic surgery, the clinical team must regularly assess the mental health of the recipients.14

issues in children

Profound developmental changes occur during the transition from childhood to adolescence and adulthood. Managing diabetes during this dynamic period can be challenging. Early transfer of responsibility from the caregiver to the child can lead to suboptimal management of diabetes and fatigue.15th Routine assessment of diabetes distress, psychosocial issues, and social determinants in patients and caregivers is essential.

conclusion

The pharmacist can play an active role in the management of diabetes and mental health (Table 17,9,12,15-18). Appropriate screening tools can help identify people who are at or at increased risk of developing anxiety, depression, diabetes, eating disorders and diabetes distress (Table 216, 19 – 21). With timely intervention, pharmacists can positively influence diabetes and mental health outcomes.

About the authors

Maria S. Charbonneau, Dr.a clinical assistant professor of pharmacy practice in the College of Pharmacy and Health Sciences at Western New England University in Springfield, Massachusetts.

Camille C. Charbonneau, PharmD, BCPS, CDOE, CVDOEis a clinical pharmacist at the CharterCARE Provider Group in Johnston, Rhode Island.

references

1. Ducat L, Philipson L, Anderson B. Mental health comorbidities of diabetes. AMA. 2014; 312 (7): 691–692. doi: 10.1001/jama.2014.8040

2. Diabetes and mental health. Mental Health America. Accessed May 9, 2022. https://www.mhanational.org/diabetes-and-mental-health

3. Lee C, Parker L, Ford ES, Chang X, Strine TW, Miqdad A. Diabetes and anxiety in adults in the United States: results from the 2006 Behavioral Risk Factor Surveillance System. Diabetes Med. 2008; 25 (7): 878-881. doi: 10.1111/j.1464-5491.2008.2477.x

4. Smith KJ, Peland M, Clyde M, et al. The association of diabetes with anxiety: a systematic review and meta-analysis. J psychological precision. 2013; 74 (2): 89-99. doi: 10.1016/j.jpsychores.2012.11.013

5. Wild D, von Maltzahn R, Brohan E, Christensen T, Clauson P, Gonder-Frederick L. A critical review of the literature on the fear of hypoglycemia in diabetes: implications for diabetes management and patient education. Patient Education Tips2007; 68 (1): 10-15. doi: 10.1016/j.pec.2007.05.003

6. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. American Psychiatric Association; 2013.

7. Learn about the collaborative care model. American Psychiatric Association. Accessed May 9, 2022. https://www.psychiatry.org/psychiatrists/practice/professional-interests/integrated-care/learn

8. Wenger K, Beverly EA. Barriers to achieving glycemic goals: Who ignores insulin and why?Diabetes care. 2010; 33 (2): 450-452. doi: 10.2337/dc09-2132

9. Fisher L, Skaff MM, Molin JT, et al. Clinical depression versus distress among patients with type 2 diabetes: It is not just a matter of semantics. Diabetes care2007; 30 (3): 542–548. doi: 10.2337/dc06-1614

10. Aikins GE. Possible associations between emotional distress and poor outcomes in type 2 diabetes. Diabetes care. 2012; 35 (12): 2472–2478. doi: 10.2337/dc12-0181

11. Fries AM, Johnson MH, Cutfield RG, Considine NS. Kindness matters: a randomized controlled trial of the Conscious Self-Compassion Intervention improves depression, distress, and HbA1c among patients with diabetes. Diabetes care.2016; 39 (11): 1963–1971. doi: 10.2337/dc16-0416

12. Conason A, Teixeira J, Hsu CH, Puma L, Knafo D, Geliebter A. Substance use after weight-loss surgery. Gamma Surge. 2013; 148 (2): 145-150. doi: 10.1001/2013.jamasurg.265.001

13. King WC, Chen JY, Mitchell JE, et al. Prevalence of alcohol use disorders before and after bariatric surgery. gamma.2012; 307 (23): 2516–2525. doi: 10.1001/jama.2012.6147

14. Greenberg I, Sogg S, M Perna F. Behavioral and psychological care in weight-loss surgery: an update of best practices. Obesity (silver spring).2009; 17 (5): 880-884. doi: 10.1038/oby.2008.571

15. Siminerio LM, Albanian-O’Neill A, Chiang JL, et al.; American Diabetes Association. Caring for young children with diabetes in childcare settings: a position statement by the American Diabetes Association. Diabetes care. 2014; 37 (10): 2834-2842

16. Screening for depression and diabetic distress in adults with type 2 diabetes. Center for Disease Control. Updated January 2017. Accessed May 9, 2022. https://www.cdc.gov/diabetes/pdfs/managing/Depression_Diabetes_Distress_Brief_508.pdf

17. Diabetes and mental health. Center for Disease Control. May 7, 2021. Accessed May 9, 2022. https://www.cdc.gov/diabetes/managing/mental-health.html

18. Cox DJ, Gonder-Frederick L, Polonsky W, Schlundt D, Kovatchev B, Clarke W. Hypoglycemic awareness training (BGAT-2): long-term benefits. Diabetes care.2001; 24 (4): 637-642. doi: 10.2337/diacare.24.4.637

19. Sabra A, Bhandari P, Sharma S, Chanpura T, Lopp L. Use of generalized anxiety disorder-2 (GAD-2) and GAD-7 in a primary care setting. treat us. 2020; 12 (5): e8224. doi: 10.7759/curius.8224

20. Davis WA, Bruce DG, Dragovic M, Davis TME, Starkstein S. Usefulness of the Diabetes Depression and Anxiety Scale in Type 2 Diabetes: Phase II Fremantle Diabetes Study. PLUS ONE. 2018; 13 (3): e0194417. doi: 10.1371/journal.pone.0194417

21. Draznin B, Aroda VR, et al; American Diabetes Association Professional Practice Committee. 14. Children and Adolescents: Standards of Medical Care for Diabetes 2022. Diabetes care.2022; 45 (Appendix 1): S208-S231. doi: 10.2337/dc22-S014

Leave a Comment