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
New Light Dawning on Depression
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
di;cult and can lead to symptoms of depression.
In turn, diabetes complications may worsen
depression, which can a;ect the ability to
communicate, think clearly, and perform
e;ectively. Most important, depression can a;ect
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.
There’s more on how diabetes
and depression are connected at
Christy L. Parkin, MSN, RN, CDE
;;;;;;;; 2012 | Diabetes Forecast 11