Depression as a Comorbidity to Diabetes: Implications for Management

Andrea A. Riley; Mindy L. McEntee; Linda Gerson; Cheryl R. Dennison

Disclosures

Journal for Nurse Practitioners. 2009;5(7):523-535. 

In This Article

Abstract and Introduction

Abstract

Research has established a link between depression and diabetes, even though the underlying mechanisms in this relationship remain unclear. Primary care providers are often responsible for managing these conditions and are well positioned to provide integrated care improving patients' physical and mental health outcomes, yet they face a number of barriers contributing to the inadequate management of depression in primary care. All diabetic patients should be routinely screened for depression; management of these concomitant conditions should use a comprehensive approach that may include medication or referral for psychotherapy. This paper explores the relationship between depression and diabetes and implications for practice in the areas of screening, diagnosis, and management of depression in diabetic patients.

Introduction

The odds of having depression among individuals with type 1 or 2 diabetes are more than twice that of non-diabetics,[1] with an estimated 33% of diabetics experiencing depressive symptoms severe enough to warrant treatment at any single point in time.[2] The course of depression in these individuals is often chronic[3] and may adversely affect the course of coexisting medical conditions.[4–6] A number of studies have found depression to be associated with poor self-care in people with diabetes.[7–13] Decreased adherence to medication,[7,10,13–15] diet,[7,8,13,14] exercise,[8,11,13] and blood glucose monitoring[13] may contribute to increased diabetic symptoms,[8,16] glucose dysregulation,[17–19] diabetic complications,[18,20,21] mortality,[22–24] decreased physical[7,8,25] and mental functioning,[7,26] lower quality of life,[7,27] and increased healthcare utilization[7,26,28] associated with comorbid diabetes and depression.

Because primary care providers (PCPs) are frequently charged with the management of type 2 diabetes and uncomplicated unipolar depression, they are well positioned to provide integrated care for these concomitant disorders.[29] While the co-occurrence of these conditions is a widely known clinical phenomenon, depression remains under-recognized and inadequately treated in primary care.[2,13,29–32] To provide high-quality care optimizing physical and mental health outcomes for their patients, it is important that PCPs understand the relationship between depression and diabetes. This paper examines the etiologies of these comorbid conditions and discusses implications for practice in the areas of screening, diagnosis, and management of depression in the diabetic population.

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