Diabetes Forecast - February 2012

| editorial

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.