Just about the only thing many diabetics don’t have a lot of on their plate is food: The disease makes for a continual process of blood glucose monitoring, taking medications, counting carbs, finding healthy recipes, and exercising — all while trying to maintain a normal life. Is it any wonder that the stress from all this, known as diabetes distress, sometimes looks like depression?
While roughly one in 10 Americans does indeed suffer depressive symptoms, chronically known as Major Depressive Disorder, researchers are increasingly finding that not all co-occurring symptoms necessarily reflect co-morbid diseases. More often than not, treating only the symptoms of diabetes distress also works to correct what physicians initially thought was depression.
"Because depression is measured with scales that are symptom-based and not tied to cause, in many cases these symptoms may actually reflect the distress that people are having about their diabetes, and not a clinical diagnosis of depression," said Dr. Lawrence Fisher, lead author of a recent study on diabetes distress and Professor of Family and Community Medicine at the University of California, San Francisco, in a statement.
Fisher’s study, presented at the American Diabetes Association's 74th Scientific Sessions, demonstrated the intervention methods designed to treat diabetes distress specifically, as opposed to more general treatment programs to address depressive symptoms. Participants were divided into three groups: an online diabetes self-management program, an individual assistance program to solve diabetes distress-related issues, and an informational program where subjects received educational material about diabetes through the mail.
Fisher and his colleagues found that all three groups reduced their distress over the 12-month period. Relying on the Personal Health Questionnaire Depression Scale (PHQ8), which scores depression between 10 (moderate) and 27 (maximum), the team found that 84 percent of participants above 10 fell below the threshold by the end of the trial.
Roughly 29.1 million people, or 9.3 percent of the U.S. population, have diabetes. Some 90 percent of those cases involve type 2 diabetes, a form of the disease marked by insulin’s deficiency, rather than its absolute absence in type 1 diabetics. Type 2 diabetics must monitor their blood sugar levels and receive insulin injections manually, as a person’s own pancreas doesn’t produce enough insulin on its own. The hormone serves to regulate glucose levels.
While researchers have long known that depression and diabetes were linked, the specific relationship wasn’t well understood. Fisher’s study, along with another unrelated study involving type 1 diabetes patients that found depressive symptoms predict early death rates, suggest the need for a more well-rounded system for evaluating diabetics’ mental health.
"What's important about this is that many of the depressive symptoms reported by people with type 2 diabetes are really related to their diabetes, and don't have to be considered psychopathology,” Fisher said. “So they can be addressed as part of the spectrum of the experience of diabetes and dealt with by their diabetes care team."