Diabetes and Mental Health: What’s the Connection?

Does diabetes cause mental health conditions or is it the other way around, if at all? Why might one make the other more likely? Or do they simply share risk or other underlying factors? You could also be wondering, if this connection is real, how do I manage diabetes and mental health? Keep reading for answers and ways to get support for both diabetes care and mental healthcare.

What is the connection between diabetes and mental health?

Diabetes is a chronic health condition that impacts how the body processes the food that’s consumed into energy. Type 1 diabetes is most commonly diagnosed in adolescence while type 2 diabetes is more prevalent later in life. Over the past two decades, the rate of diabetes mellitus in young people has risen dramatically in the U.S. Between 2001 and 2017, the percentage of youth under 20 with type 1 diabetes grew by 45%, and the percentage with type 2 diabetes grew by 95%. These significant changes mirror another phenomenon we’ve seen among children and adolescents: a decade of mental health disorders being diagnosed at higher rates.

According to the Centers for Disease Control and Prevention (CDC), there is a 2-3 times increased risk of depression among people who have diabetes compared to people who do not. The American Diabetes Association adds that type 1 diabetes in particular has also been linked with higher rates of anxiety and disordered eating. 

While research that explicitly looks into the relationship between diabetes and mental health in young people is very limited, as many as 26% of young people with diabetes may experience depression. One study examining the rates of psychiatric disorders in young people with type 1 diabetes found that 34.7% had a psychiatric disorder—another found that 47.6% did within nine years of being diagnosed with diabetes.

Many experts and medical organizations focus on the relationship between diabetes and major depressive disorder because of its prevalence. Despite how common the co-occurrence of these conditions is, only about 25-50% of people who have both diabetes and depression are diagnosed with and treated for the mental health condition.

Why does the connection between diabetes and mental health matter?

When someone is managing both diabetes and depression simultaneously, each condition can become worse in terms of self-management of diabetes, cost of treatment, diabetes complications, quality of life, and life expectancy. For example, in a survey of 4,168 people with diabetes, 487 participants who also had major depressive disorder reported increased symptoms of diabetes compared to those without major depressive disorder.

Why is there a connection between diabetes and mental health?

Experts don’t know exactly why there is a relationship between diabetes, diabetes care, and mental health, but it may connect in both ways: diabetes may lead to higher rates of depression, and depression may lead to higher rates of diabetes.

A 2015 literature review found evidence for the following hypotheses for the mechanisms linking diabetes and depression in their research (though none have demonstrated causation yet):

Psychological burden

One theory connecting diabetes with depression is that someone who has been diagnosed with diabetes may feel burdened with the diagnosis and daily diabetes care and monitoring. This psychological and healthcare burden may lead to depressive symptoms. 

Lifestyle factors

There are several lifestyle factors that researchers have hypothesized are related to diabetes and depression occurring at the same time. Some examples include less active lifestyles, less balanced nutrition, and the reduced following of treatment recommendations (e.g., medication adherence). 

The lower rates in these examples could be part of a self-reinforcing cycle: not following a treatment protocol may lead to higher blood glucose levels, which may then contribute to depression and lower uptake of treatment recommendations as a result.

Antidepressants

Some research has demonstrated an association between antidepressant use and diabetes, but whether or not the antidepressants cause diabetes hasn’t been determined. Certain antidepressant medications may contribute to weight changes as well as hyperglycemia and hypoglycemia, both of which may in turn contribute to diabetes.

Neurological factors

Several aspects of brain health and function have been hypothesized as contributing to the dual diagnosis of diabetes and depression. For example, hyper- and hypoglycemia can impact function in the areas of the brain involved in mood and cognition. These changes have been associated with mild symptoms of depression. Diabetes may also adversely affect the hippocampus in the brain and contribute to symptoms. 

Another possibility is dysfunction of the hypothalamic-pituitary-adrenal (HPA) axis, an interaction that occurs between the hypothalamus, pituitary gland, and adrenal gland. HPA-axis dysfunction may be linked with depression through altered stress hormone levels and other changes.

Additional health factors

Disrupted sleep and chronic inflammation have both been connected to diabetes as well as depression through common factors like higher levels of insulin resistance and inflammatory markers.

Environmental factors

A person’s environment before and after they are born can increase the likelihood of diabetes and depression. First, research shows that a low birth rate and overexposure to maternal stress may predispose someone to stress-related as well as metabolic disorders (type 2 diabetes falls into the latter category). Second, adverse childhood environments like poverty, exposure to violence, and residential instability may be related to higher rates of diabetes and depression (among other serious health consequences such as high blood pressure).

Is it diabetes distress or depression?

Per the CDC, although diabetes distress may sometimes look like depression, it’s not the same thing. This experience is called diabetes distress and is very common: 33-50% of people who have been diagnosed with diabetes may experience it in any 18-month period. 

Someone may experience diabetes distress if they’re frustrated by managing their diabetes care or feel like the condition is controlling everything they do. Like depression, diabetes distress may be marked by feelings of overwhelm or anxiety that reduces interest in or ability to follow treatment recommendations. 

People with depression, in contrast, may experience persistently low moods, intrusive thoughts, feelings of guilt or worthlessness, unexplained aches and pains, and other symptoms that impact daily life.

While an effective treatment for depression may include medication, the same isn’t true of diabetes distress and diabetes care. The CDC recommends the following approaches for people managing diabetes distress:

• Seeing an endocrinologist who specializes in diabetes care rather than a primary care provider or other health professional.
• Seeing a behavioral health counselor who specializes in managing chronic disease.
• Meeting with a diabetes educator.
• Working toward smaller diabetes management goals rather than major changes.
• Joining a diabetes support group.

What mental health treatments can help people with diabetes and mental health conditions?

A 2021 systematic review and meta-analysis, which examined all of the relevant research available at the time, concluded that effective diabetes care and major depressive disorder or persistent depressive symptoms treatment help with both blood sugar levels and depressive symptoms simultaneously. 

Effective treatments often include the following components in addition to medical care and diabetes medication when needed:

Psychotherapy

In psychotherapy, a client meets with a mental healthcare provider to discuss thoughts, feelings, behaviors, or any other mental health issues on a regular basis. Through the therapeutic relationship, clients can learn and practice new skills, behaviors, and thought processes—as well as get relief from the challenges they’re experiencing.

Psychotherapy may be one or a combination of therapeutic modalities, including cognitive behavioral therapy (CBT), dialectical behavioral therapy (DBT), and even arts-based therapies. Therapists will work with clients to find the right modality for them.

Group therapy

Group therapy is a type of psychotherapy that takes place in a group setting with one or more therapists and several clients. Group therapy can help people managing depression explore being vulnerable and direct with others—and, like individual psychotherapy, it also helps people navigate their emotions and challenges.

Group therapy is often an element of a comprehensive treatment plan that may also include individual therapy.

Antidepressant medication

People managing depression can be prescribed antidepressant medications. Antidepressants may work by modulating the brain’s levels of neurotransmitters (chemical messengers) serotonin or norepinephrine. These changes can help people with depressive symptoms boost their mood and improve their overall level of functioning.

Managing depressive symptoms with Charlie Health

Whether you or a loved one are experiencing persistent symptoms of depression in addition to diabetes or on their own, Charlie Health’s virtual Intensive Outpatient Program (IOP) for clients ages 11-30 can help. Our virtual IOP is designed to support children and adolescents who want or need more support than individual therapy can provide but who also want to stay connected to their current environment and daily life. 

Our expert team of compassionate and experienced clinicians will personalize a comprehensive treatment plan incorporating weekly individual psychotherapy, supported groups with other young people who are dealing with similar challenges, family therapy, and referrals for medication management with our partner psychiatrists when needed.

If you or the young person in your life would like to learn more about Charlie Health’s IOP and our philosophy of mental healthcare, please don’t hesitate to get in touch today. We’re available 24/7 to help.