Diabetes Distress Is Distinct From Depression, Researchers Say06/16/14
MONDAY, June 16, 2014 (HealthDay News) -- Although diabetes
distress is often mistaken for depression, the good news is that
simple interventions appear to help significantly reduce this
distress, according to new research.
The need to correctly identify depression is also highlighted in
a second new study. This concluded that people with type 1 diabetes
who are also depressed have a higher risk of dying early compared
to those who aren't depressed.
Both studies were scheduled for presentation this week at the
American Diabetes Association's annual meeting in San Francisco.
Because the research hasn't been published in a peer-reviewed
medical journal, it should be considered preliminary.
"We're trying to make a distinction between diabetes distress and depression. Having some level of distress is part of the spectrum of diabetes," said the author of the first study, Lawrence Fisher, a professor of family and community medicine at the University of California, San Francisco.
Diabetes distress is the emotional pain that would be expected
in someone who has to manage a demanding and chronic disease like
diabetes, Fisher said.
Feeling guilty because blood sugar isn't controlled, and feeling
overwhelmed or embarrassed by the disease are fairly typical,
Depression, on the other hand, can be diagnosed without any
indication of the source of the depressed feelings or what might
have caused them.
The current study looked at 392 people with type 2 diabetes.
Their average age was about 56, and slightly more than half were
female. The average time since their diabetes diagnosis was
approximately seven years.
People with type 2 diabetes don't produce enough insulin, a
hormone needed to convert food into fuel. Type 2 is strongly linked
to poor diet and sedentary lifestyle.
Participants were assigned to one of three interventions: a
general health appraisal, education and support; a
computer-assisted diabetes self-management program and support; or
the computer program plus problem-solving therapy that addressed
their diabetes distress directly, Fisher said.
After 4 and 12 months, people in each group "showed significant
reductions in diabetes distress," Fisher said. "But those with the
highest distress really needed the third arm intervention . . .
someone to sit down and have a conversation with them."
Bringing the emotional side of diabetes into clinical care on a
regular basis -- asking people about their blood-sugar readings
andhow they're feeling -- helps them identify and normalize
their feelings, he said.
And "addressing diabetes distress leads to better diabetes
outcomes," Fisher added.
Based on a measure of diabetes distress that his team developed,
Fisher said people with type 1 diabetes -- those who produce no
insulin -- tend to have more specific fears than those with type 2,
such as a fear of low blood sugar levels. This makes sense because
this dangerous condition occurs more often with type 1
The other, unrelated study highlights the importance of teasing
out depression from diabetes distress, especially in type 1
diabetes. This study found that over a couple of decades, people
with type 1 diabetes and depression were much more likely to die.
And the more depressed someone was, the more likely they were to
die, according to the study.
"Those with more severe [depression] symptoms were two to three times more likely to die over the next 22 years," said the study's senior author, Dr. Trevor Orchard, a professor of epidemiology, medicine and pediatrics at the University of Pittsburgh.
The study included 658 people diagnosed with type 1 diabetes
between 1950 and 1980 before age 17. Information, including a
depression evaluation, was first gathered in 1986.
Orchard said it's not clear
whyhaving type 1 and depression led to a greater risk of
"Worse adherence to treatment regimens is part of the answer, but only explains some of it," Orchard said. "Depression is also associated with worse eating habits, less exercise, lower socioeconomic status and various physiologic states, like inflammation and immunosuppression."
Even after the researchers controlled for those factors, there
was still a link between depression and a higher risk of death.
Depression and chronic disease are a bad combination, said Dr.
Joel Zonszein, director of the clinical diabetes center at
Montefiore Medical Center in New York City. "Here, it's not clear
if the disease causes the depression or if depression can worsen
Orchard said one thing is clear from this research. "Type 1
diabetes involves much more than blood sugar, and we need to
address all aspects of an individual's health. Maybe with further
study we could add depression to the list of factors to control,"
Learn more about diabetes distress from the
American Diabetes Association.
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