World Diabetes Day (WDD) is celebrated annually on November 14 with the aim of increasing awareness of the effects of diabetes and the complications caused by the disease. The number of diabetics in the world stands at 415 million as of 2015. If the epidemic of ‘Diabetes’ were a country, it would come in at third place in terms of population, behind only China and India. However, the magnitude of this problem needs no explanation. Awareness of this disease is growing and steps are being taken to curb the problem by governments, academics, medical device manufacturers, pharmaceutical companies, payers, digital health stakeholders, industry associations and patient groups. However, while the focus is usually on the physical aspects of diabetes and its serious complications, there is less emphasis on the emotional burden and psychological distress that can come with the disease itself.
Emotions in Diabetics
So what do diabetics experience emotionally? A range of emotions in reality, especially considering everyone’s awareness of the physical consequences of the disease. Here’s a quick summary:
Why Does This Matter For Diabetes?
An increasing body of scientific evidence suggests that mental health and physical health are intricately connected, to the point that some experts suggest that the two are in a reciprocal relationship. According to some estimates, if the incidence of depression is 5% in the general population, it is as high as 15-20% in diabetics; worse, in diabetics with complications, it is even higher. The converse is also true: people with depression do have a higher risk of developing diabetes. Most clinical and scientific studies agree that there is a bidirectional relationship between diabetes and depression. This, of course, does not dilute the incidence of the above outlined mental health issues that affect diabetics.
A depressed person is less likely to adhere to the demanding medication and monitoring regimens necessary for control of diabetes, automatically resulting in poor glycemic control. However more importantly, conditions such as stress or depression are known to elevate blood glucose levels amongst diabetics, even if they take their regular medication on time.
How Do We Monitor the Mental Health of Diabetics?
Unfortunately, we do not yet, or at least not routinely, monitor and evaluate the mental health of diabetics. The American Diabetes Association has released psychosocial recommendations and “guidelines to encourage comprehensive, personalized mental health assessment and treatment as part of routine diabetes care”. However, on a global level, no guidelines which encourage routine mental health assessment for diabetics exist.
There are probably two approaches to assessing and monitoring mental health for diabetics – one at the provider end when diabetics visit them for routine consultations, and the other at the diabetics’ end, where they self-monitor their condition. A true picture of the various factors that affect the lives of diabetics is shown in the image below.
Self-Monitoring
Very few available self-monitoring tools attempt to track all factors and provide a holistic picture to diabetics and their caregivers. Of the major ones that Frost & Sullivan studied, Welldoc BlueStar Rx (a prescription app in the United States) and Diabeto’s app do have the ability to track moods or stress. Tidepool’s Blip has a hashtag feature that could be leveraged as well. However, how effectively these inputs from diabetics are being integrated in managing diabetic care remains a question. More importantly, even after having diagnosed a diabetic with mental health issues, the next steps, including a possible escalation to patients’ care providers in particular mental health specialists, seem to be missing.
Provider Care
From the provider end, approaches aimed at integrating mental healthcare with primary or secondary care can work. Physicians may not necessarily be trained to diagnose mental health issues, or may simply not have the necessary time to help their diabetic patients with these issues. Both beginning by asking simple questions about moods, emotional states and social interactions in general, and leveraging available diabetes-specific screening clinical tools designed by clinicians can be pathways for physicians to help diabetics. Examples of the latter approach include the Problem Areas in Diabetes (PAID) tool and the Diabetes Distress Scale. Other tools such as the eMindLog smartphone app that are primarily designed for mental health self-tracking by patients may also be leveraged in such scenarios. Such apps or tools can help physicians assess and diagnose diabetics’ mental health, and assist in deciding whether to either treat the patient themselves or refer them on to mental health experts.
Another potential approach for doctors working with diabetics might be to partner with mental health professionals to better serve their diabetes patient community. Although this approach may already have been leveraged, and not necessarily for diabetes, it may still seem to be a cumbersome approach. Again, telehealth technology can help in this situation. To the best of our knowledge, no specific approach for diabetes exists, but mental health service providers such as Mindcare Solutions allow primary care providers to work with mental health professionals via video solutions in a telehealth format to provide holistic care to their patients. Approaches such as these will be highly effective for helping diabetics to better manage their conditions.
Summary
The importance of mental health and emotional wellbeing is slowly being acknowledged – in an environment where social determinants’ effects on health are being discussed, mental health might be the next logical step. Scientific evidences exist to prove that mental health can have a significant impact on disease management and recovery for patients, not just diabetics. This may just be the opportunity for a pioneering approach to serve diabetics holistically, to ensure better diabetes management, improved long-term outcomes and hence, overall reduction in care costs.
