Depression and diabetes

To mark the WHO‘s World Health Day 2017 which, this year, focuses on depression, we talk to Robin Hewings, head of policy for the charity Diabetes UK.

People with diabetes are twice as likely to suffer from depression th the average adult living in the UK and may also have depressive periods for longer than those without diabetes, but it is an issue that is often ignored or forgotten because the clinical priority is seen to be stabilisation and management of blood sugar levels. Having depression could also have a knock-on effect on how well diabetes is controlled.

Although depression is not a clinical symptom of diabetes, it could be the result of a variety of factors such as coming to terms with a diagnosis, dealing with the day to day responsibility of managing diabetes or the development of a diabetes-related complication.

People with Type 1 diabetes, which often begins in childhood and happens because the body cannot produce insulin, may simply feel demoralised by the day-in, day-out regime of keeping on top of their blood sugar levels. Someone with Type 1 may need to test their blood sugar levels several times a day as well asdoses of insulin throughout the day either as an injection or via a pump. Episodes of hypoglyaceamia (low blood sugar) can leave some people with diabetes feeling a like a failure as well as physically exhausted during the recovery period.

Around 3.6 million people are now diagnosed with diabetes in the UK, and 90 per cent of them have type 2 diabetes, which is linked to obesity and usually occurs in adulthood. For them, the diagnosis itself may be a shock which in turn could lead to depression. They may struggle to lose weight and take up regular exercise and so lose confidence in themselves and their ability to manage the condition.

The very serious complications of diabetes, including blindness, kidney failure and foot ulcers can mean a constant fearfulness about the future as well as frequent visits to hospital which can interfere with social and professional lives.

At Diabetes UK, we are encouraging doctors and healthcare professionals to look for symptoms of depression in patients who have Type 1 or Type 2 diabetes. A simple question like ‘how do you feel about your diabetes?’ at the annual care planning session can start a conversation about low mood and depression. Diabetes UK’s new ‘Mood information prescription’ outlines the key areas of a collaborative care management plan.

GPs are in the front line when it comes to managing patients with diabetes and they have an important role to play in helping people manage their depression as well. Of course, every individual needs a different approach. Some people with serious clinical depression may need to be referred to specialist services and have some kind of drug therapy to keep symptoms under control. For many people with diabetes who suffer with episodes of low mood, dietary and lifestyle changes such as taking regular exercise and getting enough sleep can help to ease the problem.

At Diabetes UK, we see a much greater scope for evidence-based talking therapies, such as Cognitive Behavioural Therapy for people who have diabetes and are suffering from depression. These therapies could be tailored towards the unique experience of people with diabetes and have a big impact on their quality of life.