Guest contributor Brian Ulmer, MD, is a diabetologist at St. Vincent Medical Group in Indianapolis, Indiana.
The Centers for Disease Control and Prevention (CDC) estimates that people with diabetes are two to three times more likely to have depression than people without diabetes, yet only 25 percent to 50 percent get treated.
My own experiences as a person living with type 1 diabetes and as a practicing diabetologist offer a perspective on both ends of the equation.
I was diagnosed with type 1 diabetes when I was five. Over these years, I have lived with the constant unpredictability of diabetes. Every time I thought I’d nailed it with a routine that would help me stay in my blood glucose range, I would find that I hadn’t. Diabetes was something I couldn’t escape. Ever. It is a 24/7, 365-day/year/every year disease. Omnipresent. There was never going to be a diabetes-free holiday.
The connection between diabetes and mental health is not new. Diabetes distress and diabetes burnout have been well-studied. Stress hormones may make diabetes more difficult to control and people with mental health challenges may be less motivated to properly care for themselves. The connection is powerful and goes both ways – the good news is that addressing mental health issues may help improve diabetes management as well.
How can we create a more positive environment for people with diabetes to ask for help, and for healthcare providers to improve recognition of mental health challenges? Here are five suggestions:
Healthcare providers can take a more holistic approach to treating patients with diabetes that goes beyond blood glucose control. Treating the whole person requires us to talk about lifestyle, including nutrition, exercise, and challenges to diabetes self-management. We need to listen to patients and observe body language that may be an indicator of their diabetes state of mind — stress, anxiety, depression, frustration, and even anger.
Healthcare providers can proactively ask questions to assess a patient’s diabetes state of mind, such as: How are you feeling at work? Have you noticed any feelings of sadness, hopelessness, or frustration? Have you noticed any changes in these feelings since your last visit?
During a visit — either in person or remotely — healthcare providers can assure people with diabetes who are experiencing mental health challenges that they are not alone. That it is OK not to be OK. Getting help can address issues that impact their mental health and diabetes control, and information and resources are available.
Better awareness of triggers of emotional stress can provide earlier recognition of the need to take action. Sometimes, this is as simple as feeling safe talking about this with family and friends. Sometimes, it’s voicing the need for help from a specialist or general practitioner.
Easing the way people with diabetes can manage their disease at work. There are steps employers can take at the workplace, including, promoting general wellness and offering services that assist in diabetes care in benefits programs.
Mental health is a topic that needs more attention from everyone – people with diabetes, healthcare providers, employers, and the public. A recent survey1 of US adults, including people with diabetes, showed that approximately one out of two people (51 percent) were surprised to learn of the connection between diabetes and mental health. The same survey revealed the diabetes state of mind is described as stressed, anxious, frustrated, burdened, and angry, and barriers to treatment range from lack of access to appropriate care to fear of stigma from family, friends, and work.
The fact is mental well-being may be unaddressed for years, and both diabetes care and mental health may suffer. There’s every reason, and ample opportunities, to get mental well-being more front and center so more of us can get and give the help needed.
Maybe it is because I live with diabetes myself that I am particularly attuned to my patients’ mental well-being. Or perhaps it is because I see how overwhelming all of the challenges of diabetes are for patients, such as the fear of hypoglycemia or complications like blindness and kidney disease, or issues like affordability and access to care. Either way, it’s clear to me that as professionals and patients, it’s time to appreciate that the diabetes state of mind is real. It is important to move beyond just treating glucose in diabetes, and the sooner we recognize it and talk about it more openly, the more connected people with diabetes will feel to their bodies and minds, their families, and their doctors, and will get the help they need.
Diabetes and Mental Health. Centers for Disease Control and Prevention. May 15, 2023.
10 Tips for Coping with Diabetes Distress. Centers for Disease Control and Prevention. March 31, 2022.
Dealing With Diabetes Burnout. Centers for Disease Control and Prevention. June 20, 2022.
Sharma K et al. “Stress-Induced Diabetes: A Review.” Cureus. September 2022.
[1] Data on file. Online survey of 2,033 adults 18 years and older including 325 people with diabetes conducted by Big Village in September 2023. Commissioned by Roche.
Disclaimer: Roche is not providing medical or mental health advice. This content is not, and is not intended to be, relied upon as medical or mental health advice nor is it intended to be relied upon for any medical/mental health diagnosis or treatment. Always seek the advice of a physician or other qualified healthcare professional regarding any medical/mental health questions you may have. Do not ignore medical/mental health symptoms, medical/mental health advice previously obtained from a physician or other qualified healthcare professional, or delay in obtaining medical/mental health advice based upon this content.