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.


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.


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 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.


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.


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