The Diabetes and Depression Cycle: Managing It Can Improve Blood Sugars

depression and diabetesFor some, traditional talk therapy can make a difference. For others, simple human interaction—or even connecting on Facebook—is all it takes.

If you've been diagnosed with diabetes for a while, you may know all about the vicious cycle. You may even curse it. It goes like this: Your diabetes gets depressing. You're so depressed you get discouraged, even rebellious about taking care of yourself. Your blood sugar rises. You get more depressed.

Of course, you can't help but wonder...if your depression decreases, will your blood sugar, too?

Yes, according to new research from Germany. And boosting your mood doesn't always have to involve hours on the couch at a therapist's office (although that could help if it's your thing). As long as you lower the depression, it is a good predictor of whether your blood sugar will go down, this team found. If you get rid of the depression completely, you are twice as likely to reach that golden A1C target of below 7.5, the researchers found.1

Intrigued? Here are details from the researchers, along with input from two members of the OnTrack Diabetes' editorial board who evaluated the findings.

About the Cycle

Depression can definitely take a toll on how well you take care of your diabetes, says study investigator Andreas Schmitt, PhD, a postdoctoral researcher at the Research Institute of the Diabetes Academy Mergentheim in Germany.

"Depression is associated with reduced motivation, reduced activity, suboptimal lifestyle factors such as unhealthy diet and smoking," he tells OnTrack Diabetes. If you've been in this state, you may know: your adherence to treatment goes sliding downhill right along with your mood.

Dr. Schmitt also points out that "under chronic stress conditions, blood glucose levels may vary more strongly and poorer glycemic control can result." Chronic, low-grade inflammation is linked with both stress and depression, and that could also be a factor in poorer control, he says. "There is also evidence supporting that inflammation can lead to hyperglycemia and anti-inflammatory medication might improve glycemic control." 

About the Study

The new study is a second look at a previous study, Dr. Schmitt explains. In the original study, he divided the people into a group that got cognitive or ''talk'' therapy and a group that received regular medical care for their diabetes.

After a year, those who got talk therapy had greater improvement in their depression, but the other group had less depression, too. Both groups had lower A1Cs, with no great differences there between the talk therapy or the standard care.

In this new analysis, the researchers wanted to see if the reduced depression—however it was reduced—could predict better blood sugar control.

Schmitt evaluated 181 men and women, average age 45, with type 1 and type 2 diabetes, asking them to rate their depressive symptoms. He then followed them for a year.

At the start, about three-quarters had A1Cs of 7.5 or higher, not ideal. And they scored an average of 23 out of 60 on a standard scale to rate depression. Some had major depression, others had minor, or what doctors call subclinical depression.

Study Results

After a year, the average score on the depression test dropped from 23 to 18, and nearly half got so much better they were considered recovered. 

The AIC dropped from an average of 8.8 to 8.1. And more than a third of the people got down to the target goal of under 7.5. The more the depression declined, so did the blood sugar. Those who were considered recovered were twice as likely as those who were not to reach the A1C of under 7.5.

The study is published in the Journal of Diabetes and Its Complications.1

Our Experts Weigh In

The findings make sense to Amy Hess-Fischl, MS, RD, LDN, BC-ADM, CDE, certified diabetes educator at the University of Chicago's Kovler Diabetes Center. "Worsening blood sugar control can lead to depression and depression can lead to worsening blood sugar control," she says. Hess-Fischl is a member of the OnTrackDiabetes editorial board.

She encourages people to seek help from a therapist, social worker or psychologist to modify their behavior and encourage good diabetes self-care.

For some, however, simply talking to their diabetes educator, endocrinologist, or primary care doctor may be enough, says Elena Christofides, MD, FACE, and the CEO of Endocrinology Associates in Columbus, Ohio. She is also an editorial board member for OnTrack Diabetes.

In the German study, she points out, some in the usual care group who did not get formal therapy also lowered their depression score. "Simple human interaction is enough to make people feel better," she says. It can take away the isolation and the feeling that no one's on your side. "That's why Facebook works," she says, for so many who embrace the virtual friend world.

The goal, Dr. Christofides says, is to reduce the depression in a way that works for you. That could be talking to your doctor, taking medication, getting therapy, or some combination, she says. "Keep trying different things until you find something that works for you."

Dr. Schmitt reports no disclosures.

Updated on: September 1, 2017
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