A specific concern for those with diabetes is diabetes distress—feelings of overwhelming frustration and burnout related to the daily demands of managing the condition. This distress is not effectively treated by typical depression or anxiety medications and can lead to unhealthy habits, such as skipping blood sugar checks or doctor's appointments.
The Double Risk of Diabetes and Mental Health Conditions
There is a powerful bidirectional link between diabetes and mental health issues:
- Individuals living with diabetes have a 2–3 times greater risk of developing depression compared to those without the condition.
- Conversely, depression increases the risk and severity of diabetes.
Shared risk factors, such as poor sleep, lack of exercise, and unhealthy diet, contribute to chronic stress, hormonal imbalances, and increased inflammation, linking both conditions. Furthermore, long-term antidepressant use may increase diabetes risk, and fluctuations in blood sugar directly affect brain function, mood, and cognitive ability.
Mental Health Conditions Associated with Diabetes
Individuals with diabetes are at a higher risk for other mental health issues:
- Anxiety: People with diabetes are 20% more likely to experience anxiety at some point in their lives. The constant management of the condition, along with the potential for complications or a new diagnosis, acts as a major source of anxiety. It is important to note that anxiety symptoms can mimic hypoglycemia (low blood sugar), requiring blood sugar checks for proper diagnosis.
- Eating Disorders: Women with type 1 diabetes face an increased risk of eating disorders, including diabulimia (purposely restricting insulin for weight loss). Older research suggests that eating disorders occur in 31–40% of women with type 1 diabetes between the ages of 15 and 30.
The Impact of Mental Health on Diabetes Management
Co-occurring mental health conditions like depression or anxiety can complicate diabetes management and worsen a person's health outcomes:
- Reduced Motivation: Individuals may become less motivated for self-care activities.
- Poor Lifestyle Habits: Depression is associated with being more sedentary and having an unhealthy diet, leading to higher blood sugar levels.
- Increased Risks: Smoking is more common among people with mental health conditions, increasing the risk of diabetes complications like stroke and heart disease.
- Treatment Adherence: Older research indicates that people with mental health conditions may struggle more with following treatment plans, attending appointments, and maintaining glucose monitoring and foot care.
Mental health medications are safe to use for people with diabetes. However, many antidepressants and anti-anxiety drugs can affect how the body processes glucose and responds to insulin, potentially making blood sugar control more difficult. Doctors may recommend adjusting these medications if blood sugar levels become too high.
Disparities in Mental Health and Type 2 Diabetes
Black and Hispanic people in the U.S. face a higher likelihood of experiencing depression alongside type 2 diabetes. This disparity is rooted in systemic and socioeconomic factors:
Healthcare Access: These groups are often uninsured or underinsured. A 2012 statement from the Endocrine Society noted that people with diabetes lacking insurance receive a lower quality of care. This leads to a higher risk of developing complications and more advanced disease at diagnosis, both of which significantly increase the risk of depression.
Socioeconomic Factors: Societal barriers often result in lower socioeconomic status, which increases the risk of type 2 diabetes and contributes to depression.
Environmental Stressors: Factors like childhood adversity, chronic stress, decreased access to healthy food stores, and a lack of safe places to exercise are linked to poor diets, decreased physical activity, diabetes, and depression.
Suggestions for Managing Mental Health with Diabetes
It is essential for anyone who suspects they have depression or anxiety to contact their doctor immediately. A doctor can provide a referral to a mental health professional for treatment, which may include therapy and medication. Successfully treating a mental health condition directly supports better diabetes management.
Individuals can also adopt lifestyle strategies for better coping:
- Find healthy ways to lower stress and anxiety.
- Maintain a healthy diet and stay active.
- Limit consumption of alcohol and caffeine.
- Ensure adequate rest.
- Maintain supportive relationships with friends and family.
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