Diabetes Distress Is Distinct From Depression, Researchers Say

New studies look at the emotional fallout from type 1 and type 2 disease

Monday, June 16, 2014

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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, Fisher said.

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 and how 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 diabetes.

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 why having type 1 and depression led to a greater risk of death.

"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 the disease."

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," Orchard said.

SOURCES: Trevor Orchard, M.D., professor, epidemiology, medicine and pediatrics, University of Pittsburgh, Penn.; Lawrence Fisher, Ph.D., professor, department of family and community medicine, University of California, San Francisco; Joel Zonszein, M.D., director, clinical diabetes center, Montefiore Medical Center, New York City; June 15 & 17, 2014 presentations, American Diabetes Association meeting, San Francisco

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