The combination of diabetes and depression offers a challenge to patients and healthcare providers alike. We are beginning to see how the two conditions are related. There appears to be a bi-directional relationship. Having diabetes is associated with a 20% increased risk of developing depression, while having depression is associated with a 60% increase in developing type 2 diabetes.
Some explanations for this relationship may be related to the substantial burden of managing diabetes. Patients fear that diabetes can adversely affect their lives and may develop symptoms of depression such as emotional distress, loss of energy or interest, and difficulty concentrating.
Patients already suffering from depression may exhibit behaviors that increase their risk of developing diabetes, such as lack of exercise and poor dietary choices. Obesity is common in patients with depression and also in patients with type 2 diabetes.
Depression and diabetes are both associated with the stress hormone, cortisol. Excess cortisol raises the blood sugar and contributes to insulin resistance, and can worsen depressive symptoms.
Guidelines from the American Diabetes Association recommend that patients with diabetes be evaluated for depression. Proper treatment for depression can decrease the risk of complications from diabetes by improving adherence to medications and self-care activities. Studies have also suggested that treatment for depression may help normalize blood sugars. Treatment options for depression include cognitive behavioral therapy and/or pharmacotherapy.
Exercise is beneficial for both conditions as well. Patients can lower their blood sugar and improve depressive symptoms with regular exercise. Diabetes self-management education can help with disease management and coping skills and should be offered to patients to give them better control of their lives.
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