Diabetes Forecast

New Light Dawning on Depression

By Christy L. Parkin, MSN, RN, CDE ,

Feeling down occasionally is normal. But sometimes an unrelenting sadness takes over and it won't go away. Serious depression can strike anyone, but people with diabetes are at greater risk. Similarly, people with depression have a greater risk of developing type 2 diabetes. Diabetes and depression are usually thought of as separate conditions, but there is growing evidence that they are linked.

The connection may be stress, suggests Frank Hu, MD, PhD, professor of nutrition and epidemiology at the Harvard School of Public Health. People who are depressed have elevated levels of stress hormones such as cortisol, which can lead to problems with glucose metabolism, increased insulin resistance, and the accumulation of belly fat—all diabetes risk factors, Hu says.

Whether diabetes causes depression, or vice versa, has been a subject of much research that isn't yet fully understood. But we do know that the stress and demands of managing diabetes are difficult and can lead to symptoms of depression. In turn, diabetes complications may worsen depression, which can affect the ability to communicate, think clearly, and perform effectively. Most important, depression can affect blood glucose control, worsen quality of life, and lead to smoking, unhealthful eating, and lack of physical activity, all risk factors for type 2 diabetes.

When someone has both diabetes and depression, the prognosis is worse—in terms of severity, complications, treatment, and mortality—and the costs to both the individual and society are significantly higher than having just one condition. Complicating matters, people may receive a diagnosis and treatment for one of the conditions, but not both. This is unfortunate, because both conditions are treatable.

The American Diabetes Association is one of many nongovernmental organizations and government agencies that have joined in a global initiative known as the Dialogue on Diabetes and Depression (DDD). It aims to raise awareness of the challenges posed by the combination of diabetes and depression, and to help health care providers recognize the dual conditions and manage them better. The first major training initiative by the DDD, along with the International Council of Nurses, was a program in October 2011 to train nurses in six African countries. In Africa, nurses are sometimes the only health care providers available and play an important role in delivering primary care. The DDD plans to extend the program to countries in other parts of the world.

Increasing awareness of the link between diabetes and depression should lead to better diagnosis and treatment of the two conditions, as well as other cases of comorbidity, when a person has to deal with more than one disease at the same time. That's a big challenge for medicine in the 21st century. Stay tuned for more news on this groundbreaking initiative and more research about improving the health of people living with diabetes and depression.



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