Mental health and diabetes experts expressed their concern about the need for more mental health screening and treatment resources for patients with diabetes, in an opinion article published in the Journal of the American Medical Association. Senior author Dr. Barbara Anderson, a professor of pediatrics – psychology at Baylor College of Medicine and Texas Children’s Hospital, highlights the risk of depression, diabetes distress, anxiety, and eating disorders in people with the disease.

Only one-third of the 29.1 million people who suffer from diabetes in the United States and from a mental health comorbidity receive a diagnosis or treatment for mental health issues, according to the American Diabetes Association. The presence of two chronic diseases or conditions in one patient is reason for attention, according to Anderson. However, there are few facilities that provide mental health screenings or integrate mental health or behavioral health services into diabetes care.

“The incidence of both type 1 diabetes and type 2 diabetes is on the rise, so this is the right time to talk about the consequences of the mental health co-morbidities of diabetes before they lead to poor mental and physical health outcomes for increasing numbers of people with diabetes and bankrupt the healthcare system,” said Anderson. “The mental health aspects of diabetes have been significantly overlooked in the setting of diabetes health care.”

Diabetics are two times more predisposed to depression, especially young adults with type 1 diabetes, due to poor health outcomes. “If a person with diabetes is depressed or struggling with diabetes distress, it is very difficult to be motivated and sustain the level of self-care needed to successfully manage diabetes,” she explained. The combination of diabetes and depression have also been scientifically proved to increase the risk of poor adherence to treatment, poor glycemic control, higher rates of diabetes complications and impaired quality of life.

“Diabetes distress is now recognized as a mental/behavioral health condition separate from and more common than clinical depression. Diabetes distress occurs because virtually all of diabetes care is self-management behavior—requiring balance of a complex set of behavioral tasks by the person and family, 24 hours a day, without ‘vacation’ days,” said the authors.

Anxiety is another condition that caught the attention of the authors, as it is associated with an initial diagnosis or when complications of diabetes first occur, the authors noted. Also a challenge for diabetes self-management are the fear of hypoglycemia, anxiety about maintaining blood glucose levels in a healthy range, as well as anxiety about injections and blood draws. “Anxiety disorders complicate living with diabetes and its management,” the authors wrote.

Women are particularly more vulnerable to eating disorders, as the researchers explain the risk of developing the illness more than doubles among women with type 1 diabetes, compared to women who don’t suffer from diabetes. It is particularly troubling, since an eating disorder combined with type 1 diabetes leads to poorer glycemic control, higher rates of hospitalization, increased risk for retinopathy and neuropathy and premature death

“Diabetes is a chronic and progressive condition; and the complex, daily treatment of diabetes is completely in the hands of the person and family living with diabetes in collaboration with a health care team.” said Anderson. “Cognitive behavioral therapy combined with psychotropic medication has been shown to help some people with diabetes who suffer from depression.”

“The high prevalence and costs of depression in the context of diabetes combined with evidence that behavioral factors are important for effective diabetes self-management create a unique opportunity to integrate mental health screening and treatment into multidisciplinary team diabetes care, to help improve patient and public health outcomes, and decrease health care expenditures,” the authors explained, as they recommend that identifying and treating mental health issues among patients should be a priority.

In addition to Dr. Anderson, the founder of The Mental Health Issues of Diabetes Foundation in Philadelphia, Lee Ducat, and the professor of medicine and pediatrics and director of the Kovler Diabetes Center University of Chicago, Louis H. Philipson, authored the commentary.