Type 2 Diabetes and Depression: Not Just Two Separate Diagnoses

Receiving a diagnosis of Type 2 diabetes can be stressful, and can significantly impact ones’ life. The term “diabetes distress” refers to the emotions (such as guilt, anxiety, denial) that can arise due to the stress of living with diabetes and the burden of self-care that accompanies a diagnosis of a chronic illness. About 45% percent of people with Type 2 diabetes additionally suffer from diabetes distress, which is associated with decreased glycemic control and supportive self-management behaviors. However, while diabetes distress might be an outcome of a chronic illness diagnosis that we might intuitively expect, what is less recognized is the association between Type 2 diabetes and depression. People with diabetes are 2-3x more likely than those without diabetes non-diabetic counterparts to have depression – unfortunately, only 20-50% of diabetic individuals actually receive a diagnosis of depression and subsequent treatment.

Current research shows that supports a bi-directional, synergistic, and complicated relationship between Type 2 diabetes and depression. comorbid having diabetes and depression leads to increased risk in mortality and an increased risk regarding complications of diabetes.  Some of these complications are retinopathy, cardiovascular disease, neuropathy, nephropathy, and cerebrovascular disease. Research has also shown that depression in diabetes leads to worsening control of blood sugar that can exacerbate these conditions. at a clinically significant level.

While we don’t know fully why diabetes and depression interact this way, we do have some of the puzzle pieces. As discussed earlier with diabetes distress, depression can alter one’s ability to engage in the self-management behaviors that appropriate glycemic control in diabetes requires. Depression influences our sense of self-efficacy, which understandably alters how we engage with food, movement, monitoring blood glucose, et cetera. However, there appears to be more to the story than that. One 5-year prospective cohort study actually controlled for socioeconomic, clinical and health behavior factors, and yet, still found worse outcomes for those with both related to comorbid diabetes and depression.

One idea that has been suggested as an explanation is that of chronic stress. Chronic stress leads to activation of the hypothalamus – pituitary – adrenal axis, as well as our sympathetic nervous system. These all lead to increased insulin resistance, production of inflammatory cytokines, and a decreased response from neural rewards pathways. These in turn lead to increased risk for both diabetes and depression. This discussion of chronic stress additionally focuses on all the various ways social determinants of health (like access to good food and housing) affect our physical and mental well-being, and how social inequities play a role in health.

Regardless of whether we know the exact mechanism through which Type 2 diabetes and depression interact, it is important that you check in with your doctor to make sure you have been screened for depression if you have diabetes, and that you receive treatment. As naturopathic doctors, we have many tools to help address both chronic stress, diabetes and depression, and we can work with you to brainstorm what type of support you need most.  Book an appointment at Bastyr Center for Natural Health in Seattle or Bastyr University Clinic in San Diego. 

Author: Logan Rost, ND, MPH, CHES

References:

Centers for Disease Control and Prevention. (2018). Diabetes and Mental Health. Retrieved from https://www.cdc.gov/diabetes/managing/mental-health.html.

 Katon, W. (2010). Depression and Diabetes: Unhealthy Bedfellows. Depression and Anxiety, 27, 323-326. doi: 10.1002/da.20683.

 Krieder, Kathryn Evans. (2017). Diabetes Distress of Major Depressive Disorder? A Practical Approach to Diagnosing and Treating Psychological Comorbidities of Diabetes. Diabetes Ther, 8, 1-7. doi: 10.1007/s13300-017-0231-1.