In an editorial published last week in the Journal of the American Medical Association, mental health and diabetes experts described a critical need for more mental health screening and treatment resources for people with diabetes.
Louis Philipson, MD, PhD, professor of medicine and pediatrics and Director of the University of Chicago Medicine Kovler Diabetes Center, co-authored the editorial, along with Barbara Anderson from Baylor College of Medicine and Texas Children’s Hospital, and Lee Ducat, founder of The Mental Health Issues of Diabetes Foundation in Philadelphia, and a founder of the Juvenile Diabetes Foundation.
“We’re missing the boat in identifying and treating mental health issues in diabetes,” Philipson said. “Diabetes is 24/7/365. There’s never a vacation, there’s never a rest. You can’t take a day off, or even an hour when you have diabetes, and that leads to considerable mental health issues with being able to maintain vigilance over your health.”
The Centers for Disease Control and Prevention estimate that 29.1 million people, or 9.3 percent, of the United States population, have diabetes. Currently, only one-third of people with diabetes who also cope with a mental health issue receive a diagnosis or treatment for these issues, according to the American Diabetes Association. About 10 percent of those have type 1 diabetes that requires multiple injections of insulin per day. Both types are increasing.
People with diabetes have two times greater the risk for depression, especially young adults. Those with depression are at risk for poor adherence to treatment, poor glycemic control, higher rates of diabetes complications and impaired quality of life.
Many people with diabetes also suffer from anxiety associated with the initial diagnosis or when complications of diabetes first occur. The authors also noted that women with type 1 diabetes are at double the risk of developing an eating disorder than those without.
Despite these issues, few diabetes clinics or centers provide mental health screenings or integrate mental health and behavioral health services into diabetes care. The Kovler Diabetes Center is one of the few such clinics in the United States that offers a fully-integrated, psychosocial support program for patients.
Kovler’s Health and Wellness program provides comprehensive psychosocial assessments and follow up care for patients in the endocrinology clinic. Behavioral health specialists with expertise in diabetes counseling staff the clinic five days a week, and conduct initial assessments with patients and their families, from pediatric to geriatric patients.
These specialists consult with endocrinologists on how to incorporate the appropriate mental health care into the overall treatment plan. Health and Wellness staff can also provide brief, follow up psychotherapy sessions to bridge patients until they have been referred to an appropriate local provider, and continue to consult with patients during ongoing endocrinology checkups.
Tina Drossos, PhD, assistant professor in the Department of Psychiatry and Behavioral Neuroscience and Director of the Health and Wellness program, said that the close partnership with the endocrinology clinic helps patients overcome the initial hurdle of asking for help.
“A lot of patients are reluctant to talk about their diabetes in the first place,” she said. “Mental illness still has stigma associated with it, so a lot of patients are not willing to talk about it either.”
Drossos said they have seen a significant improvement in patients’ A1c levels—a standard measure of blood glucose control—as mental health improves. The program oversees research on how emotional and social support factors influence more objective health measures like this for patients with diabetes.
Identifying and treating mental health issues among patients should be a priority, the authors of the JAMA editorial concluded.
“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,” they said.