Groundbreaking Study Links Mental Health and Chronic Diabetes Complications Both Ways

Millions of Americans managing diabetes face an increased risk of severe complications, such as heart attack, stroke and nerve damage. However, a groundbreaking study led by the University of Michigan has revealed that the relationship between diabetes and mental health disorders is bidirectional. This means that those who suffer from chronic diabetes complications are more likely to have mental health disorders, and vice versa.

“We wanted to see if chronic diabetes complications led to mental health disorders or if mental health disorders led to those diabetes complications – but we found that both relationships are true,” senior author Brian Callaghan, the Eva L. Feldman Professor of Neurology at U-M Medical School, said in a news release.

The findings, published in Diabetes Care, underscore a crucial need for health care providers to simultaneously screen for mental health disorders and chronic diabetes complications, which is currently part of the recommended diabetes care standard.

Three Times Greater Risk

The researchers analyzed insurance claims data from over 500,000 individuals with type 1 or type 2 diabetes and 350,000 people without diabetes.

Their study found that people with chronic diabetes complications have up to a three-times greater risk of developing mental health conditions, such as anxiety or depression. Conversely, individuals with mental health disorders are up to 2.5 times more likely to experience sustained diabetes complications.

In younger adults (under 60), chronic complications were more prevalent among those with type 1 diabetes, whereas type 2 diabetes was more commonly associated with mental health difficulties.

Interdependency Explained

The bi-directional relationship between mental health disorders and diabetes complications indicates that each condition can directly influence the other.

“For instance, a stroke causes detrimental effects on the brain, which may directly lead to depression,” Callaghan added.

Furthermore, managing diabetes while having a mental health condition can impact one’s self-care practices adversely, such as poor glycemic control or inconsistent medication usage, thereby increasing complication risks, he explained.

Common Risk Factors and the Need for Integrated Care

Shared risk factors, including obesity, glycemic control issues and social determinants of health, further compound the co-occurrence of diabetes and mental health disorders.

“Most likely, a combination of direct and indirect effects and shared risk factors drive the association we are seeing,” first author Maya Watanabe, who was a graduate student research assistant at U-M at the time of the study and is currently a biostatistician at the Harvard T.H. Chan School of Public Health, said in the news release.

This integrated perspective on diabetes care could enable prevention of multiple complications. However, implementing such a holistic approach requires additional resources. The U.S. Preventive Services Task Force emphasizes that patients who screen positive for mental health conditions should be “appropriately diagnosed and treated with evidence based care or referred to a setting that can provide the necessary care.”

Co-author Eva Feldman, U-M James W. Albers Distinguished University Professor, expressed concerns over the overworked health care system.

“Primary care providers and endocrinologists are already overworked; therefore, systems of care need to be in place to help provide mental health care when needed,” she said.

She advocated for mental health screening, easily accessible insurance coverage for mental health services and comprehensive education programs for both physicians and patients.

The study calls for immediate action to integrate mental health care within diabetes management frameworks. Such preemptive measures could mitigate the risk of severe health complications and improve the overall quality of patient care.