Diabetes mellitus is a complex chronic disease that requires constant self-management and is known to pose psychological and emotional burdens, placing affected individuals at a higher risk of developing diabetes distress, depression, and anxiety, along with other mental disorders.^1–3 Nevertheless, with proper diagnosis and early treatment, diabetes-related mental health disorders can be effectively managed.

DIABETES DISTRESS

Individuals with type 1 or type 2 diabetes commonly experience diabetes distress. Around 33-55% of individuals with diabetes are known to have diabetes distress in any given 18-month period.⁵ It is an entity separate from major depressive disorder.¹ 

Diabetes can leave an individual feeling overwhelmed with the burdens of self-care, feeling concerned about complications, and feeling guilty when management is not going as planned. ^1,4 Such emotional distresses are characteristic of diabetes distress and have been related to poor treatment adherence, poor glycemic control, higher rates of complications, and decreased quality of life.

It is important to recognize and manage diabetes distress, as diabetes distress has similar symptoms as depression or anxiety, but its treatment strategies differ. The Centers for Disease Control (CDC) provides the following recommendations to manage diabetes distress:⁵
 

• See an endocrinologist for diabetes care
• See a diabetes educator to help problem-solve
• See a mental health counselor specializing in chronic health disease
• Join a diabetes support group
• Focus on meeting 1-2 diabetes management goals at a time

DEPRESSION

Depression is a mood disorder characterized by sadness, low mood, insomnia, and lack of energy, interest, and ability to enjoy life.^5–7 Research suggests that a bidirectional relationship exists between depression and diabetes.¹ Individuals with type 1 or type 2 diabetes are 2-3 times more likely to have depression, and individuals with depression also have an increased risk of developing diabetes. 

It is important for individuals to check if they experience any of the following symptoms and speak promptly with their doctor, psychotherapist, or counselor if they do:⁸

• Loss of interest or pleasure in things you used to enjoy
• Sadness, hopelessness, nervousness, guilty, or anxiety
• Loss of energy
• Changes in sleep patterns or appetite
• Difficulties in concentrating
• Declining work or school performance
• Suicidal thoughts

Even though depression is common, less than half of those struggling get diagnosed and treated.⁵ Like diabetes distress, untreated depression is associated with nonadherence to treatment plans, poor glycemic control, higher rates of complications, increased work disability and unemployment, and impaired quality of life. However, depression can be treated effectively in individuals with diabetes using various therapies.^1,4 Psychotherapy, antidepressant pharmacotherapy, and collaborative patient-centered treatment can improve both depression and glucose control.

ANXIETY AND STRESS

An individual can experience different forms of anxiety and stress when first diagnosed with diabetes or when first experiencing a diabetes complication.¹ These anxiety disorders include generalized anxiety disorder, posttraumatic stress disorder, or panic disorder. Symptoms of anxiety can include avoidance of certain people, places, or events, rapid heart rate, dizziness, sweating, headaches, and gastrointestinal distress.⁹

It is important to recognize and manage anxiety disorders.¹ Serious anxiety disorders and hypoglycemia have similar symptoms, which can potentially delay the immediate treatment of hypoglycemia. Anxiety and fear of hypoglycemia can also cause an individual to maintain their blood glucose levels above target range. Additionally, previous anxiety about needles and blood draws can exacerbate into panic disorders, further complicating disease management. Lastly, research suggests that stress can be a catalyst to developing diabetes among individuals with high risk factors for the disease.⁹

The CDC provides several recommendations to lower stress and anxiety:⁵

• Exercising
• Calling or texting a friend who understands you
• Limiting alcohol and caffeine
• Getting adequate sleep