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Mental-Health Risks of Diabetes Underrecognized
July 23, 2014 (Medscape) - Among the wide-ranging comorbidities associated with diabetes, mental-health issues are probably among the most overlooked, despite their potential to compromise self-management and increase the risk for serious complications, according to a new viewpoint published online July 10 in the Journal of the American Medical Association.
"Despite the potential adverse effects of mental-health problems on diabetes outcomes and healthcare expenditures, only about one-third of patients with these coexisting conditions receive a diagnosis and treatment," write Barbara J. Anderson, PhD, of the Baylor College of Medicine department of pediatrics, in Houston, Texas, and colleagues.
Published data underscore the prevalence of mental-health illness associated with diabetes: rates of major depressive disorder, which affects 6.7% of adults in the United States, are 2 times greater among individuals with type 1 or type 2 diabetes across a lifespan. And depression is higher among youth with type 1 diabetes, compared with those without the disease, according to a 2011 meta-analysis (Gonzalez JS. Depression. In: Peters A, Laffel L, eds. Type 1 Diabetes Sourcebook. 2013:169-179).
While researchers work to better understand the mechanisms linking diabetes and depression, it's clear that the relationship is bidirectional, Dr. Anderson told Medscape Medical News. "Having depression raises your risk for onset of diabetes, just as having diabetes raises your risk for onset of depression," she said.
"Currently, the neuropsychology of diabetes and brain and neural-network changes in diabetes and depression are the 'new frontier' in behavioral research in diabetes," she added.
She also notes that physicians are not good at recognizing mental-health issues among diabetic patients, so education is needed to help them understand this and to encourage them to refer people to mental-health teams so they can get treatment.
Anxiety and Eating Disorders Also Common in Diabetes
The mental-health effects associated with diabetes aren't limited to depression, however — panic disorder, generalized anxiety disorder, and posttraumatic stress disorder (PTSD) are also common among those with diabetes, with or without comorbid depression, according to the report.
Importantly, because anxiety symptoms can overlap with symptoms of hypoglycemia, patients can be confused about whether or not low blood glucose is the cause, requiring immediate treatment.
And patients experiencing anxiety over the confusion may wind up overtreating themselves, resulting in blood glucose above target levels, the authors note.
While less is known about eating disorders in males with diabetes, the problem is significant among women — those with type 1 diabetes in fact have twice the risk of developing a full-blown eating disorder and a 1.9-fold risk of developing a subthreshold eating disorder, compared with those without diabetes, research shows.