Exploring the Impact of Mental Health on Diabetes Management
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They carefully examine all references and facts to provide up-to-date and reliable information, aiming to break myths and empower you in your health journey.
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Dr Neelesh Bhandari
India is inching towards becoming the Diabetic Capital of the world, with more than 101 million of its population living with diabetes while an additional 136 million live with prediabetes, as per a recent ICMR study titled Metabolic non-communicable disease health report of India: the ICMR-INDIAB national cross-sectional study (The Lancet Diabetes & Endocrinology, Published: June 07, 2023).Â
Diabetes is also the leading cause of blindness, kidney failure, amputations, and a major risk factor for heart disease, stroke, and cancer. In this alarming situation, leading physicians recommend holistic care along with early psychological support in diabetes management to prevent long-term complications.
Even the American Diabetes Association and the European Association for the Study of Diabetes recommend focussing on the social determinants of health and physical activity behaviours under the holistic approach to diabetes management (Diabetes Care 2022;45(11):2753–2786).Â
Mental Health Challenges Associated with Diabetes
Diabetes being a chronic metabolic disorder, affects the physical, social and mental health of the patient. Psychological challenges associated with diabetes management include anxiety, lowered mood with impaired ability to self-care, poor eating habits and the fear of developing diabetes-related complications. These mental health issues in diabetes may eventually develop into poor quality of life (QoL), reduced general well-being and depression.
Bidirectional Relationship between Mental Health and Diabetes
Multiple lines of evidence point towards a bidirectional relationship between mental health and diabetes. Anderson et al. reviewed 39 studies with a sample size of 20,218 subjects to come to the conclusion that there is two times more chance of developing depression among people living with diabetes than non-diabetic individuals in the control group. The study further suggested that diabetic women (28% probability) are more prone to experience depressive symptoms than diabetic men (18% probability).Â
Even CDC’s report on Diabetes points out that mental health and diabetes are closely associated. Diabetic patients have 20% more chances of developing anxiety. Mental Health America also suggested that 33-50% of people living with diabetes are likely to experience diabetes distress at some point in life. Similarly, people suffering from depression have an increased risk of developing diabetes.
How does mental health impact the clinical presentation of diabetes?
People living with diabetes often experience a spike in blood sugar levels due to chronic stress. Subsequent release of stress hormones (cortisol and catecholamines) disturbs glucose homeostasis and prevents muscles and white adipose tissue from absorbing glucose. This results in hyperglycemia, leaner body mass loss, visceral fat accumulation, and insulin resistance (Sharma K et al., Stress-Induced Diabetes: A Review. Cureus. 2022 Sep 13;14(9):e29142).
Role of Mental Health Support in Diabetes Care
A Fitterfly study led by Neha Verma et al. (Diabetes 2022;71(Supplement_1):601-P) reveals that customised virtual stress management and behaviour therapy sessions helped manage diabetes distress among 100 T2DM (Type 2 Diabetes Mellitus) members who enrolled on Fitterfly Diabefly Program for 90 days. Participants’ motivation levels improved significantly by 9.39% from a baseline score of 33.70 to 37.42 (post-program), while their diabetes distress reduced by 24.21% from a baseline score of 1.90 to 1.35 (post-program).
Figure 1: Graph showing improvement in Diabetes Distress and Motivation level after enrolling in the 90-days Fitterfly Diabefly Program (in a sample size of 100)
Another Fitterfly study led by Tejal Lathia et al. (Endocrine Abstracts (2023) 90 P375) involving 175 participants living with diabetes (74 females and 101 males) pointed out that multi-disciplinary care via digital therapeutics interventions helped in reducing the Diabetes Distress Scale (DDS) score and Pittsburgh Sleep Quality Index (PSQI) by 0.50 and 3.00 points respectively from a baseline score of 1.90 and 5.00 respectively. Their fasting blood sugar levels also significantly decreased by 25.00 from a baseline score of 142.00. After the successful completion of 90-days Fitterfly Diabetes Program, members overall sleep quality improved by 56% and sleep duration improved by 59%, while their average HbA1c was reduced by 1.20%.
Figure 2: Graph showing improvement in Diabetes Distress, Pittsburgh Sleep Quality Index Score, and Fasting Blood Sugar Level among 175 participants in 90-days Fitterfly Diabetes Program.
Findings by Rahul Alam et al. (Patient Educ Couns. 2009 Apr;75(1):25-36.) pointed out that regular psychology counselling in diabetes management can reduce the HbA1c level by 0.5%–1% among people living with T2DM.
Types of Mental Health Support in Diabetes Management
Psychological support in diabetes care is provided through multiple strategies and therapies to achieve good glycemic control. They include psychosocial interventions like Intensive Behavior Therapy (IBT), Cognitive Behavior Therapy (CBT), Mindfulness-based Interventions, Gestalt Therapies, Motivational Enhancement Therapy (MET), Motivational Interviewing, and the COM-B Model of Behavior Change. These therapies, in addition to attaining good glycemic control, also improve self-care behaviour, enhance patients’ quality of life, and avoid long-term complications of diabetes.
Integrating Psychological Support in Diabetes Care
Physicians have the ability to integrate psychological interventions into the existing treatment regimen by incorporating scientifically-validated digital therapeutic programs, such as Fitterfly Diabetes Prime, to provide psychological support in diabetes care.
Qualified psychologists conduct comprehensive mental health assessments of patients using structured questionnaires, enabling them to create detailed profiles. Personalized and highly customized intervention plans are then designed based on the findings of the psychometric assessments. These interventions may include psycho-education on the four pillars of diabetes management, guidance on mindful eating, and techniques like box breathing to effectively manage stress and alleviate diabetes distress.
It is crucial for physicians to prioritize the well-being of mental health in diabetes patients within diabetes care. This entails implementing psychological screening and management at every stage of diabetes treatment. Furthermore, physicians should consider recommending patients to clinically-proven digital therapeutic programs (DTx) that offer psychological guidance from qualified psychologists. This holistic approach ensures comprehensive care and addresses the psychological needs of individuals living with diabetes.
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