Stress and depression can affect how diabetics look after themselves

by Barbara Hewitt on January 25, 2013

Stress and depression can affect how diabetics look after themselves

Doctors are seeking reliable ways of predicting stress, anxiety and depression among diabetics to give them a practical way of helping people. Australian diabetes experts, psychiatrists and neuroscientists say that measuring depression and disease related distress in patients with diabetes means they can quickly identify those who need treatment.

They have also shown that distress is influenced by heritable genetic changes in the way patients’ bodies handle serotonin, a neurotransmitter that regulates mood. Their aim is to help clinicians quickly identify those people who need psychiatric guidance or counselling to manage their diabetes and to provide practical ways of helping.

Experts have also been looking at the control of blood sugar levels against the degree of disease related distress and the relationship between depression and anxiety and the presence or absence of a common variant in genes that regulate serotonin levels. In their study they looked at 184 patients of which 75% had type 2 diabetes and the rest type 1 diabetes. They completed a questionnaire, agreed to serotonin genotyping and were also interviewed to assess their depression history.

Quote from : “I have seen discussions about stress and high blood sugar many times, on the diabetes sites. My impression is that stress does cause high blood sugar for almost all diabetics.”

‘Our Psychosomatics paper clearly showed that diabetes related distress predicts the level of chronic blood glucose control, and we saw a high level of distress in people related to their disease,’ said Professor Lesley Campbell, senior clinical researcher at the Garvan Institute of Medical Research in Sydney and director of Diabetes Services at St. Vincent’s Hospital. ‘When people are distressed, it interferes with their ability to look after themselves and most clinicians are at sea as to how to handle that. They talk about non-compliant patients, but they don’t figure the distress of the patient as part of the story,’ she explained.

‘Although this study looks specifically at diabetes, it is also a paradigm for other chronic disease distress management, including coronary heart disease and stroke,’ she added.

Professor Kay Wilhelm, a liaison psychiatrist at St. Vincent’s Hospital and Professor Peter Schofield, executive director of Neuroscience Research Australia, have been studying the effects of people’s serotonin genotype on their ability to regulate emotion. Those with a specific variant appear to be more excitable and less able to control their emotions in a crisis. ‘Diabetes is known to be a chronic stressor and we wanted to see if there were reliable ways of predicting stress, anxiety and depression to give doctors a practical way of helping people,’ said Professor Wilhelm.

‘It’s interesting to note that a person’s genetic make-up predicts their ability to cope with stress, and that in turn determines their level of distress. While depression and distress both affect a person’s ability to cope with diabetes, distress is easier to measure. We’re now working on an algorithm to identify people at risk and personalise their treatment options,’ he explained.

‘Ideally, we’d like to see patients complete a questionnaire in the waiting room. That would allow the treating clinician to see immediately whether or not they have a high distress score and then give appropriate advice. Importantly, we plan to give clinicians some ideas about what to do in the case of high distress,’ he added.

Professor Wilhelm has created a series of business card sized brief interventions to enable people to deal better with stressful situations, including chronic health conditions. She is making them into an app for smart phones.

The opinions expressed in this article do not necessarily reflect the views of the Community and should not be interpreted as medical advice. Please see your doctor before making any changes to your diabetes management plan.

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