Indeed, “depression is common in patients with diabetes, particularly patients with poorly controlled diabetes (twice that of the general population),” says Dr Bavi Vythilingum, a psychiatrist at Akeso Clinic Kenilworth, advises.
In addition, “anxiety disorders are also common, including panic disorder and Post-Traumatic Stress Disorder (PTSD), which is sometimes related to the stress of medical complications, especially in children with diabetes. Anxiety symptoms can overlap with hypoglycaemia symptoms.
“Younger patients with diabetes particularly those with type 1 diabetes are also at risk for acting out behaviours, depression, and eating disorders. Adolescence is a time of rebelling and testing limits. Many adolescents with diabetes express this by becoming non-compliant. It’s important to be aware of this so that it can be detected, as well as understood and managed appropriately,” she adds.
In an article titled Diabetes and Depression: A devastating duo, author Zane Wilson points out “that while “most people with diabetes do not have depression, studies show that people with diabetes have a greater risk of depression than people without diabetes. Depression is not generally listed as a complication of diabetes.”
Psychiatric disorders inevitably affect the lives of diabetic individuals on several levels.
According to the Indian Journal of Endocrinology and Metabolism, “co-occurring psychiatric disorders in patients with diabetes are associated with impaired quality of life, increased cost of care, poor treatment adherence, poor glycaemia control (evidenced by elevated HbA1c levels), increased emergency room visits due to diabetic ketoacidosis, higher frequency of hospitalisation, and higher rate of absenteeism.
“Additionally there is an increase in cost of medical care. Cost of care for non-mental health conditions among patients with co-occurring psychiatric disorders and endocrinal disorders is twofold or even higher (depending on the treatment setting) than the population without co-occurring psychiatric disorders.
Signs of psychological problems
Vythilingum says poor diabetic control, withdrawal, anger and irritability, especially around treatment, low mood, stopping or refusing treatment or follow-up and failure to adhere to the advised diet, can all be signs of psychological illness as a result of diabetes.
“Being supportive, non-judgmental and suggesting and facilitating that the person seeks professional help from someone to address these issues, can go a long way in positively assisting a diabetic patient with a psychological disorder,” she points out.
According to her binge eating disorders can lead to high Body Mass Index (BMI), which is a risk for diabetes. “Any eating disorder impacts on diabetic control,” she stresses.
“One study found as many as 31% to 40% of women with type 1 diabetes between the ages of 15 and 30, in fact, have disturbed eating behaviours, including binging and purging through insulin restriction. This places them at high risk of hyper and hypoglycaemia and long term complications of diabetes due to poor control.
“The necessary focus on eating, blood sugar and symptom control places diabetics at risk for eating disorders as well as for anxiety disorders,” she adds.
“It is important that mental health disorders in patients with diabetes are treated.
“Mindfulness-based interventions can be useful in managing depression and anxiety associated with diabetes. These can also help patients improve their compliance and develop more agency in controlling their illness. Like with any chronic disorder, acceptance is most important. Mindfulness, DBT and other psychotherapies – in which the Akeso Group of Psychiatric Clinics are specialists – can aid in this,” she says.
Don’t give up! “Sometimes diabetics can be viewed as weak, unfit, unhealthy and so forth. This is part of the stigma of the illness. They are often judged on what they eat and what they weigh and are blamed for their illness. There is the perception that “they didn’t diet or exercise, so it’s their fault that they have diabetes,” Vythulingum adds.
This should not deter diabetics from trying to manage their condition. “It doesn't matter if you make mistakes or don't get your treatment perfect - as long as you don't give up. Also, seek support – Diabetes Support South Africa (https://www.diabetessa.org.
(Adapted from press release)