When individuals experience long-term complications from diabetes, like heart issues, strokes, or nerve damage, there’s an increased likelihood of facing mental health challenges, and the reverse is also true, as indicated by a study. Researchers emphasize the importance of health professionals routinely checking for mental health disorders in diabetes patients, alongside monitoring for chronic complications, which is currently considered the standard practice in diabetes care.
Heart issues, strokes, nerve damage.
These are among the complications millions of Americans with diabetes face at an increased risk.
A study led by the University of Michigan shows that individuals with these chronic diabetes complications are more prone to mental health disorders, and the relationship is reciprocal: having a mental health issue can also elevate the risk for chronic diabetes complications.
“Our goal was to determine if chronic diabetes complications resulted in mental health disorders or if the opposite was true, but we discovered that both scenarios occur,” explained Brian Callaghan, M.D., M.S., the senior author and the Eva L. Feldman, M.D., Ph.D., Professor of Neurology at U-M Medical School.
“These findings stress the need for clinicians to routinely assess mental health issues among diabetes patients in addition to the standard checks for chronic complications.”
Tripled Risk
The research team from Michigan Medicine and the Department of Biostatistics at the U-M School of Public Health evaluated insurance claims data from over 500,000 individuals with type 1 or type 2 diabetes, alongside about 350,000 individuals without diabetes.
Results published in Diabetes Care show that those with chronic diabetes complications were up to three times more likely to have mental health issues like anxiety or depression, and this risk heightened with age.
Individuals with mental health disorders faced up to 2.5 times higher chances of enduring lasting diabetes complications.
In adults under 60, type 1 diabetes was more strongly linked with chronic complications, whereas those with the more prevalent type 2 diabetes were more prone to mental health struggles.
Researchers suggest that this mutual relationship might be due to the direct impacts of either a complication or mental health issue on the likelihood of developing the other.
“For example, a stroke can harm the brain, potentially leading to depression,” Callaghan noted.
“Moreover, having both a mental health issue and diabetes could hinder a person’s ability to manage their diabetes effectively—resulting in poor blood sugar control or non-adherence to medication—which may, in turn, heighten their risk of complications.”
Shared Risk Factors
The connection between diabetes complications and mental health issues may also involve less direct factors. Conditions like obesity, difficulty managing blood sugar levels, and social determinants can increase the likelihood of developing both types of health issues.
“It’s likely that a combination of direct and indirect influences, along with shared risk factors, contributes to the association we’re observing,” said Maya Watanabe, M.S., the lead author and a biostatistician at Harvard T.H. Chan School of Public Health and former graduate research assistant at U-M.
“Diabetes care providers can potentially decrease the risk of various complications by addressing these common risk factors.”
According to the CDC, up to 50% of diabetes patients might experience feelings of distress related to their condition within any 18-month timeframe.
While some national diabetes centers have started screening for depression and distress among their patients, there is currently no standardized approach for mental health screening within diabetes care.
The researchers acknowledge that additional resources will be necessary for the mental health assessment and treatment, as many diabetes care clinicians lack specific training in detecting and addressing these issues effectively.
Caring for Mental Health
This aligns with the statement from the U.S. Preventive Services Task Force, which asserted that patients who test positive for mental health issues must be “properly diagnosed and treated with evidence-based care or referred to a facility that can provide the necessary care.”
“Primary care practitioners and endocrinologists are already overloaded; consequently, support systems must be established to facilitate mental health care as needed,” stated co-author Eva Feldman, M.D., Ph.D., Director of the ALS Center of Excellence and James W. Albers Distinguished University Professor at U-M.
“These systems should involve mental health screenings, accessible insurance for mental health services, and educational programs for both physicians and patients. Immediate action is crucial, and our findings further underline the urgency of this need.”
