Depression in People with Type 2 Diabetes: Prevalence and Treatment Strategies
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The relationship between type 2 diabetes and depression is a two-way street according to recent research presented by Jeffrey S. Gonzalez, Ph.D. from Yeshiva University.
Not only do people with depression have a higher risk of developing type 2 diabetes, people with type 2 diabetes are more likely to develop depression after diagnosis.
“If patients did everything we told them to do, they’d be spending more than two hours a day on diabetes self-management,” said Gonzalez, highlighting that the actual burden of living with diabetes is far heavier and overwhelming than simply eating a healthy diet and checking your blood sugar.
Gonzalez points out that calling it “depression” may be misleading if the emotional toll is actually related specifically to the burden of diabetes. Instead, “diabetes distress” may be more appropriate, and identifying it is critical because it will likely impact a person’s daily self-care.
Gonzalez summarizes the burden of type 2 diabetes management as:
- Long-term persistence with adherence to medications
- Dietary and lifestyle changes
- Physical activity and exercise requirements
- Self-monitoring of blood glucose levels
- Foot self-care
- Medical appointments and preventive care
- Management of co-occurring illness
- Constant problem solving
Findings on the relationship between diabetes and depression/ “diabetes distress” include:
- While it might be easy to assume the higher blood sugar levels contribute to the development of depression in someone with diabetes, the rate of depression in people already diagnosed with diabetes was significantly higher than those who were unaware they had diabetes. This means a person’s blood sugar levels aren’t the significant contributor to depression. Instead, it’s the diagnosis and burden of managing the disease.
- Levels of depression are highest in the months and the year immediately following the diagnosis.
- Depression is also a huge predictor of whether a person would develop diabetes-related complications. And the diagnosis of a diabetes-related complication then increases a person’s risk of developing depression.
- 36 percent of adults with diabetes report clinically significant levels of diabetes distress, more so than general depression, and it’s closely related to diabetes management and reaching A1c goals.
Most effective treatment options for depression in people with type 2 diabetes:
- Cognitive Behavioral Therapy for Adherence and Depression (CBT-AD) has proven to be the most effective in treating depression while improving a person’s daily diabetes self-care and health outcomes.
- CBT-AD proved effective in helping people with diabetes take their medications as prescribed, check their blood sugar levels more frequently, make progress towards their A1c goals and reduce the overall severity of their depression.
- When comparing CBT-AD to “enhanced usual care” (EUC) to help people with diabetes and depression, A1c results after four months of treatment were a full point lower in the CBT-AD group.
Gonzalez emphasized that screening people with type 2 diabetes for general depression may miss those struggling with diabetes distress, and it’s important to tailor screening processes.
Common symptoms of depression include:
- General depressed mood
- Loss of interest in usual activities
- Fatigue or low energy
- Sleep disturbance (insomnia or excessive sleeping)
- Changes in your appetite or weight
- Feelings of guilt, worthlessness, low self-esteem
- Difficulty concentrating and remembering things
- Thoughts of death or suicidality
If you are struggling with thoughts of suicide, reach out to your healthcare team or call Talk Suicide Canada at 1-833-456-4566, Kids Help Phone at 1-800-668-6868, the Hope for Wellness Help Line at 1-855-242-3310, and 1 866 APPELLE (277-3553) (Quebec residents), that all offer 24/7 support. You can also get help from a local crisis centre.
