The diagnosis and management of diabetes can be a significant life stressor for individuals and their families, and may be associated with challenges regarding illness acceptance and treatment participation. Addressing concerns regarding illness beliefs and participation in treatment recommendations can be helpful.
The lived experience of diabetes is often associated with struggles specific to the illness and can lead to significant concerns, specifically diabetes distress, perpetuation of stigma, reluctance to initiate insulin when recommended, and the persistent fear of hypoglycemic episodes.
Psychological Reactions to the Diagnosis of Diabetes
Well-established reactions to diabetes include: perceptions about the seriousness of the disease (either discounting the seriousness of diabetes, which is often seen in those with asymptomatic type 2 diabetes [T2D], or becoming overwhelmed by the diagnosis, often seen in individuals and families with type 1 diabetes [T1D]); not comprehending the extent to which diabetes can be managed; the degree of personal responsibility required for management; and the perceived benefits and barriers to taking action. Professional support to address these reactions can be helpful in promoting self-management of diabetes.
Stigma Associated With Diabetes
Weight-based stigma—the perception and experience of being discriminated against due to one’s body weight—can be perpetuated by providers in health-care settings. When present, this can lead to worsening distress, diminished quality of life, as well as decreased diabetes self-management behaviours. Health-care providers must be aware of their own biases and be able to communicate in a non-stigmatizing manner about weight-related issues and diabetes management.
Financial Burden of Diabetes
Diabetes is an expensive illness to live with and to manage well. People living with diabetes should ask their health-care teams for help and health-care providers should recognize the key role they play in accessing financial supports. Advocacy and activism are helpful and often necessary to manage the cost of living with diabetes.
The costs associated with diabetes can have effects on the physical and emotional well-being of people with diabetes.
Risks Associated With Diabetes and Psychiatric Conditions
A wide range of psychiatric disorders (beyond the serious mental illnesses of major depressive disorder [MDD], bipolar and related disorders, and schizophrenia spectrum disorders) put people at higher risk for developing diabetes (usually T2D) compared to the general population.
People living with diabetes and MDD are at increased risk for earlier all-cause mortality compared to people living with diabetes without a history of MDD.
Compared to those with diabetes only, individuals with diabetes and mental health concerns are at risk for functional impairment, diabetes complications, and increased health-care costs, often coupled with decreased participation in diabetes self-care and decreased quality of life.
Diabetes in Pregnancy
Individuals with diabetes in pregnancy are at an increased risk of developing mental health disorders (e.g. depressive and anxious symptoms) and psychological distress throughout the pregnancy. Receiving effective emotional and tangible support, in addition to medical advice, can help buffer these negative outcomes.
Risks for Children and Adolescents
Youth with diabetes are at risk for having psychosocial symptoms and diabetes self-management difficulties. Regular assessments during routine diabetes care are especially helpful during adolescence and the transition to young adulthood.
It is important to also assess the emotional functioning of the whole family/home environment—including parent/caregiver distress and fear of hypoglycemia—in order to understand the potential impact of these influences on younger people with diabetes.
Diabetes in Older Adults
Depressive symptoms in older adults with T2D are an important risk factor for cognitive impairment and are associated with an increased risk of earlier mortality.
Older people with T2D experience an increased disease burden and are more likely to have multimorbidity (an increased likelihood of complications and other adverse outcomes).
Substance Use and Diabetes
Substance use is linked with multiplicative health risks and can be a factor in the development of new-onset T2D, as well as worsening health outcomes among those with established diabetes.
Smoking cigarettes and/or alcohol consumption are risk factors for the development of T2D and adverse cardiovascular events in people with established diabetes.
People prescribed insulin are more susceptible to the harmful effects of recreational substance consumption, particularly alcohol use.
Screening for substance use followed by a brief intervention can be helpful, and approved pharmacotherapies for tobacco, alcohol, and opioid use disorders are safe for use in people with diabetes.
COVID-19
People with diabetes are at higher risk for developing more severe complications from a COVID-19 infection. Preventative measures, such as keeping a safe distance from others, wearing a mask in public, regular handwashing, and keeping up to date on vaccinations, help reduce the risk of acquiring the virus and potentially the severity of the illness.
Screening and Assessment
All individuals with diabetes, as well as the parents or caregivers of youth with diabetes, should be screened at appropriate intervals for the presence of diabetes distress, as well as symptoms of common psychiatric disorders.
People with diabetes are at risk for developing a wide array of mental health conditions—especially mood and anxiety disorders—and should be screened regularly for symptoms that may be part of a psychiatric condition.
Psychosocial Treatment Approaches to Managing Diabetes
Person-centred approaches using motivational interviewing, cognitive behaviour therapy (CBT), acceptance and commitment therapy, stress management, coping skills training, family therapy, and collaborative case management should be incorporated into primary care, wherever possible.
Building self-management skills, employing educational interventions that facilitate adaptation to diabetes, and addressing co-occurring mental health issues that reduce diabetes-related distress, fear of hypoglycemia, and reluctance to initiate insulin when recommended, are all helpful.
Use of Psychotropic Medications
There are effective treatments for the disabling symptoms that comprise psychiatric conditions. Regular use of medication can be a crucial element in helping people maximize their function and reduce symptom severity.
Monitoring Metabolic Risks
Individuals taking psychiatric medications, particularly (but not limited to) atypical antipsychotics, benefit from regular screening of metabolic parameters to identify glucose dysregulation, dyslipidemia, and changes in weight (and possibly other anthropometric measures) throughout the course of the illness so that appropriate interventions can be instituted if necessary.
