Diabetes and depression are chronic debilitating conditions that are associated with high rates of complications and death, and increased healthcare costs. People with diabetes who have depression often find it more difficult to follow diabetes treatment recommendations, and have poor metabolic control, higher complication rates, increased healthcare use and costs, increased disability and lost productivity, lower quality of life as well as increased risk of death. Coordinated strategies for clinical care are necessary to improve the health of people with diabetes and depression, and to reduce the burden of illness.
Prevalence of depression in people with diabetes
Worldwide estimates of depression prevalence among people with diabetes appear to vary by diabetes type and among rich and poor nations. Studies have shown that people with diabetes are more likely to have depression than individuals who do not have diabetes. However the mechanisms linking these conditions are not entirely clear. A review of studies found that depression was associated with a 60% increase of type 2 diabetes while type 2 diabetes was only associated with a moderate (15%) increase in risk of depression 1 .
Effects of depression
People with diabetes need to successfully manage their disease to avoid complications. Studies have shown a significant relationship between depression and poor adherence to self-management guidelines, which is confirmed by the higher rate of diabetes complications among those who have depression.
People with diabetes and depression are at greater risk of disability, reduced work productivity and lower quality of life. They are also at greater risk of death, as shown in a study that found the coexistence of diabetes and depression is associated with significantly higher risk of death, beyond that due to having either diabetes or depression alone 2 (See Figure 2.5).
Source: Egede et al, 2005 2
Healthcare and treatment
As would be expected healthcare costs are higher for people with diabetes and coexisting depression. In the USA, people with diabetes and depression had higher diabetes-related medical costs (USD3,264) than those with diabetes alone (USD1,297) 3 . However, evidence suggests that treatment of depression in people with diabetes is both efficacious and cost effective and can result in improved overall diabetes outcomes.
Many people with diabetes and depression are treated in primary care settings, but studies indicate that consistent recognition and treatment of depression is less than optimal in primary care settings 4 . One barrier to early recognition and treatment of depression is the difficulty in separating the symptoms of depression from the symptoms of poor control of diabetes.
The challenges of treating people with diabetes and depression are influenced by both the individual and the healthcare system. Factors such as stigma and poor provider knowledge have limited the chances of people with diabetes and depression receiving optimal quality care.
Effective management of people with diabetes and depression requires a multidisciplinary approach. In many clinical settings, care for the person with diabetes is fragmented and requires referral to practitioners in the different disciplines, who in many cases are located at a distance from each other. Coordinated clinical care requires the implementation of effective strategies to increase the recognition of depression, the adoption of evidence-based interventions, and the integration of quality measures for the management of depression into diabetes clinical guidelines.
The background paper, Diabetes and Depression, on which this summary is based is available in the Downloads section.
1: Mezuk B, Eaton WW, Albrecht S, et al. Depression and type 2 diabetes over the lifespan: a meta-analysis. Diabetes Care 2008; 31 (12): 2383-2390.
2: Egede LE, Nietert PJ, Zheng D. Depression and all-cause and coronary heart disease mortality among adults with and without diabetes. Diabetes Care 2005; 28 (6): 1339-1345.
3: Le TK, Able SL, Lage MJ. Resource use among patients with diabetes, diabetic neuropathy, or diabetes with depression. Cost Eff Resour Alloc 2006; 4: 18.
4: Egede LE. Failure to recognize depression in primary care: issues and challenges. J Gen Intern Med 2007; 22 (5): 701-703.