Diabetes and mental health

Abstract

This narrative review summarises the research into five common mental health problems that can affect adults living with type 1 diabetes, type 2 diabetes or gestational diabetes: fear of hypoglycaemia, diabetes distress, depression, disordered eating, and disordered sleep. The evidence shows that diabetes distress, fear of hypoglycaemia and mental health problems are common among adults with diabetes and can substantially decrease quality of life and self-care, and increase the risk of adverse health outcomes, such as higher HbA1c, greater co-morbidities and premature mortality. Many mental health problems are bidirectionaly linked to diabetes. Randomised controlled trials have shown that psychological interventions are effective to reduce symptoms in the short term, including cognitive behavioural therapy, mindfulness-based cognitive therapy, and stepped care, which can also be offered digitally as a first step. However, diabetes distress, depression and other mental health problems are known to recur and the longer term outcomes of prevention or treatments are yet unclear. In general, mental problems are understudied in gestational diabetes. People with diabetes want to talk with their diabetes health professionals about the emotional side of living with and managing diabetes. These findings support integration of routine monitoring and psychological support into clinical practice. Health care policy makers should make sure that diabetes healthcare professionals are well-equipped and enabled to discuss mental health and refer to appropriate digital health tools and mental health specialists when needed.

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ORCID for Richard I.G. Holt: orcid.org/0000-0001-8911-6744

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