Rates of depression are significantly higher for patients with diabetes, especially those who are elderly, when compared with people without diabetes. About 20% to 30% of patients with diabetes suffer from clinically relevant depressive disorders. “Depression can worsen glycemic control in those with diabetes,” says Jason C. Baker, MD. Research suggests depression is associated with a higher risk of developing diabetes complications and adverse outcomes. Conversely, improving depressive symptoms has been shown to lead to better glycemic control.
“Depression can result in reduced physical activity and a greater need for medical care and prescriptions, which in turn can increase healthcare costs and worsen quality of life,” Dr. Baker says. “In order to improve the management of patients with these two conditions, it’s imperative that healthcare providers be aware of this link and its consequences.” He adds that effective pharmacologic and non-pharmacologic treatments are available and may be of benefit in some situations.
The stress of managing diabetes on a daily basis and the effects of the disease on the brain may contribute to depression, according to Dr. Baker. “There are multiple factors that may be at play, but one of the most important things clinicians can do is screen patients with diabetes for depression,” he says. “Oftentimes, physicians focus solely on the chief complaint or on A1C, blood pressure, and cholesterol numbers. We need to take a more holistic approach and be vigilant about seeking out depression or other mental health problems. This should become a routine part of all diabetes care.”
Dr. Baker says that it can be challenging to address depression when managing patients with diabetes because of the stigma associated with mental health issues. “Instead of labeling patients as depressed, it may make more sense to ask patients about their mood during every patient encounter,” he says. “If signs of depression or mental health problems appear, the next step should be to recommend counseling or treatment with a trusted specialist in mental health. A list of these providers should be readily available and given to patients when needed.”
A Delicate Line
According to Dr. Baker, it is important to find out if patients follow through when psychiatric care is recommended. However, he says that diabetes specialists should be careful with how this is handled. “If patients don’t use the referral, it’s important to find out why and be prepared with alternative strategies,” says Dr. Baker. “If they do go to their referral, physicians should continue to inquire about mood and mental health during each encounter. By being proactive about mental health, we can help patients avoid the potential consequences of depression and its impact on diabetes care.”
Simon GE, Katon EH, Lin E, et al. Diabetes complications and depression as predictors of health service costs. Gen Hosp Psychiatry. 2005;27:344-351.
Gonzalez JS, Safren SA, Cagliero E, et al. Depression, self-care, and medication adherence in type 2 diabetes: relationships across the full range of symptom severity. Diabetes Care. 2007;30:2222-2227.
Lustman PJ, Clouse RE. Depression in diabetic patients: the relationship between mood and glycemic control. J Diabetes Complicat. 2005;19:113-122.
Simon GE, Katon WJ, Lin EH, et al. Cost-effectiveness of systematic depression treatment among people with diabetes mellitus. Arch Gen Psychiatry. 2007;64:65-72.
Katon W, Unutzer J, Fan Jr MY, et al. Cost-effectiveness and net benefit of enhanced treatment of depression for older adults with diabetes and depression. Diabetes Care. 2006;29:265-270.