Depression was found to be associated with hyperglycemia (HbA1c), high risk of complications and excess mortality. This unfortunate association is not fully understood. It may be explained by the disruptive effects of stress on blood glucose regulation as well as by poor self-management, i.e. poor diet and/or erratic eating behaviors, low physical activity, poor adherence to medicine taking and  low frequency of self-testing of blood glucose.  Given the burden of depression and its clinical ramifications, timely recognition by diabetes professionals and adequate management of depression and high distress is pivotal. International guidelines, including IDF, advocate implementing periodic monitoring of psychological well-being in routine diabetes care and screening for depression in those at high risk. However, overall recognition of emotional distress in clinical practice is suboptimal, identifying roughly a third to half of the patients at high risk for depression. Many depressed diabetes patients fail to receive psychological treatment.  

Barriers in detecting and discussing depression in diabetes care are partly professional and partly patient-related. Professionals may lack knowledge and time to examine and discuss mood problems as part of their consultation. As to patient-related factors, lack of understanding and feelings of shame and stigmatization may hamper reporting symptoms of distress and be open to psychological help. This raises the question how to best improve practice with regard to depression management, particularly in busy, low-resourced settings.  First, patient and professional education is key in fostering awareness and openness to discuss depression in the context of diabetes. Second, risk factors for depression need to be understood and addressed. Screening for depression can be supported with validated instruments to help identify those at high risk. Third, depression referral and care pathways, addressing also diabetes-specific issues known to cause high distress, need to be in place. For this purpose multi-disciplinary teamwork is warranted, with close collaboration between diabetes and mental health professionals. For the purpose of expending reach, internet-based education and counseling can be helpful where online technology is available.

How do you address emotional distress in your patients?  Do you collaborate with a mental health specialist? 

Information about the discussion leader

The discussion will be moderated by Prof Frank J Snoek, Professor, chair Department of Medical Psychology. VU University Medical Center (VUMC) and Academic Medical Center (AMC) University of Amsterdam, the Netherlands.

References

1. Snoek FJ, Bremmer MA, Hermanns NH. Constructs of depression and distress in diabetes: time for an appraisal. Lancet Diabetes Endocrinology, 2015; 3(6), 450-460.
2. Van Bastelaar KM, Pouwer F, Cuijpers P, Riper H, Snoek FJ. Web-based depression treatment for type 1 and type 2 diabetic patients: a randomized controlled trial. Diabetes Care 2011, 34: 320-25.
3. Snoek FJ, Kersch NY, Eldrup E, Harman-Boehm I, Hermanns N, Kokoszka A, Matthews DR, McGuire BE, Pibernik-Okanović M, Singer J, de Wit M, Skovlund SE. Monitoring of Individual Needs in Diabetes (MIND)-2: follow-up data from the cross-national Diabetes Attitudes, Wishes, and Needs (DAWN) MIND study. Diabetes Care. 2012 Nov;35(11):2128-32.
4. Anderson RJ, Freedland KE, Clouse RE, Lustman PJ.The prevalence of co-morbid depression in adults with diabetes: a meta-analysis. Diabetes Care. 2001 Jun;24(6):1069-78.