Shed light on diabetes and mental health


Appropriate screening tools can help identify people at increased risk or suffering from anxiety, depression and eating disorders.

People with diabetes are at increased risk for anxiety, depression and eating disorders.1

Additionally, diabetes can lead to mental health issues related to diabetes-related distress.2 Mental health issues can act as barriers to diabetes self-management and can increase the risk of long- and short-term diabetes complications.1

Despite the profound impact that mental health issues can have on diabetes care, only about a third of people with diabetes are diagnosed and treated.1 Without appropriate and timely identification and management of comorbid mental health issues, the patient’s health and financial well-being can be significantly affected. Substantial costs to the health care system may also arise.


The lifetime prevalence of generalized anxiety disorder in people with diabetes is approximately 20%.3 Complications and disease progression, inability to meet blood glucose goals, fear of hyperglycemia or hypoglycemia, unawareness of hypoglycemia and insulin administration are commonly reported concerns .4.5 Pre-existing fears of needles and blood can be exacerbated by a diagnosis of diabetes and can lead to severe anxiety or panic disorders.1 Additionally, people with excessive diabetes self-management behaviors may have obsessive-compulsive disorder.6

Fear of high blood sugar or ignorance of low blood sugar may cause some patients to deliberately keep their blood sugar above target. Parents of children with type 1 diabetes (T1D) may also encourage this practice due to the same fear.1 Additionally, symptoms of low blood sugar, such as heart palpitations, sweating, and shaking, can mimic symptoms of anxiety disorders, making it difficult for people with anxiety and diabetes to discern the difference.

The Depression

Type 2 diabetes (T2D) increases the risk of developing major depressive disorder (MDD) and MDD increases the risk of developing type 2 diabetes, suggesting that they may have a bidirectional relationship.1 Antidepressants and psychotherapy for the treatment of depression in people with diabetes have shown minimal effects on blood sugar management and moderate effects on depression. The Collaborative Care Model, a primary care model integrating behavioral health and general medicine, showed significant positive effects on depression and blood sugar management.1.7

Eating disorders

Women with T1D have a 2 times higher risk of eating disorders.1 Eating disorders, such as binge eating and calorie purging with insulin restriction, may be seen in 31% to 40% of women aged 15 to 30 with diabetes.1.8 Diabetes and comorbid eating disorders increase the risk of poor blood sugar management, hospitalizations, neuropathy, retinopathy, and premature death.1

Diabetes Distress

Diabetes distress is a significant psychological stress resulting from the emotional burden of managing chronic, progressive disease without “vacation days”.1.9 Over an 18-month period, approximately 38% to 48% of people with diabetes experience diabetes-related distress.ten High levels of diabetes-related distress can negatively affect diabetes management and quality of life, leading to poor eating and exercise behaviors and medication adherence, as well as decreased blood sugar management.9.10 Cognitive-behavioral and social problem-solving approaches and self-compassion programs have been shown to reduce diabetes-related distress.11

side note

Recipients of metabolic surgery may be at increased risk for anxiety, depression, development or worsening of substance abuse, and suicidal ideation. Clinicians and patients should address significant underlying mental health issues before considering surgery.12-14 After metabolic surgery, the clinical team should regularly assess the recipients’ mental health.14

Problems in children

Profound developmental changes occur during the transition from childhood to adolescence and adulthood. Managing diabetes during this dynamic time can be challenging. Premature transfer of responsibilities from caregiver to child can lead to suboptimal diabetes management and burnout.15 A systematic assessment of diabetes-related distress, psychosocial problems and social determinants in patients and caregivers is needed.


Pharmacists can play an active role in diabetes and mental health management (Table 17,9,12,15-18). Appropriate screening tools can help identify people with or at increased risk of anxiety, depression, diabetes-related distress, eating disorders, and diabetes-related distress (Table 216.19-21). With timely intervention, pharmacists can have a positive effect on diabetes and mental health outcomes.

About the authors

Maria S. Charbonneau, PharmDis Clinical Assistant Professor of Pharmacy Practice at Western New England University College of Pharmacy and Health Sciences in Springfield, Massachusetts.

Camille C. Charbonneau, PharmD, BCPS, CDOE, CVDOEis a clinical pharmacist at CharterCARE Provider Group in Johnston, Rhode Island.


1. Ducat L, Philipson L, Anderson B. Mental health comorbidities of diabetes. WADA. 2014;312(7):691-692. doi:10.1001/jama.2014.8040

2. Diabetes and mental health. Mental Health America. Accessed May 9, 2022.

3. Li C, Barker L, Ford ES, Zhang X, Strine TW, Mokdad AH. Diabetes and anxiety in American adults: results from the 2006 Behavioral Risk Factor Surveillance System. Diabetes Med. 2008;25(7):878-881. doi:10.1111/j.1464-5491.2008.02477.x

4. Smith KJ, Beland M, Clyde M, et al. Association of diabetes with anxiety: a systematic review and meta-analysis. J Psychosome Res. 2013;74(2):89-99. doi:10.1016/j.jpsychores.2012.11.013

5. Wild D, von Maltzahn R, Brohan E, Christensen T, Clauson P, Gonder-Frederick L. A critical review of the literature on fear of hypoglycemia in diabetics: implications for diabetes management and education patients. Patient Education Tips.2007;68(1):10-15. doi:10.1016/j.pec.2007.05.003

6. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. American Psychiatric Association;2013.

7. Learn about the collaborative model of care. American Psychiatric Association. Accessed May 9, 2022.

8. Weinger K, Beverly EA. Barriers to achieving glycemic goals: who is omitting insulin and why?.Diabetic treatments.2010;33(2):450-452. doi:10.2337/dc09-2132

9. Fisher L, Skaff MM, Mullan JT, et al. Clinical depression versus distress in patients with type 2 diabetes: not just a matter of semantics. Diabetic treatments.2007;30(3):542-548. doi:10.2337/dc06-1614

10. Aikens I. Prospective associations between emotional distress and poor outcomes in type 2 diabetes. Diabetic treatments. 2012;35(12):2472-2478. doi:10.2337/dc12-0181

11. Friis AM, Johnson MH, Cutfield RG, Consedine NS. Kindness matters: A randomized controlled trial of a mindful self-compassion intervention improves depression, distress, and HbA1c in patients with diabetes. Diabetic treatments.2016;39(11):1963-1971. doi:10.2337/dc16-0416

12. Conason A, Teixeira J, Hsu CH, Puma L, Knafo D, Geliebter A. Substance use after bariatric weight loss surgery. JAMA Surgery.2013;148(2):145-150. doi:10.1001/2013.jamasurg.265

13. King WC, Chen JY, Mitchell JE, et al. Prevalence of alcohol use disorders before and after bariatric surgery. JAMA.2012;307(23):2516-2525. doi:10.1001/jama.2012.6147

14. Greenberg I, Sogg S, Perna M F. Behavioral and psychological care in bariatric surgery: an update of best practices. Obesity (Silver Spring).2009;17(5):880-884. doi:10.1038/oby.2008.571

15. Siminerio LM, Albanese-O’Neill A, Chiang JL, et al. ; American Diabetes Association. Caring for young children with diabetes in child care settings: a position statement from the American Diabetes Association. Diabetic treatments.2014;37(10):2834-2842

16. Screening for depression and diabetes-related distress in adults with type 2 diabetes. CDC. Updated January 2017. Accessed May 9, 2022.

17. Diabetes and mental health. CDC. May 7, 2021. Accessed May 9, 2022.

18. Cox DJ, Gonder-Frederick L, Polonsky W, Schlundt D, Kovachev B, Clarke W. Blood glucose awareness training (BGAT-2): long-term benefits. Diabetic treatments.2001;24(4):637-642. doi:10.2337/diacare.24.4.637

19. Sapra A, Bhandari P, Sharma S, Chanpura T, Lopp L. Use of generalized anxiety disorder-2 (GAD-2) and GAD-7 in a primary care setting. priest. 2020;12(5):e8224. doi:10.7759/cureus.8224

20. Davis WA, Bruce DG, Dragovic M, Davis TME, Starkstein S. The utility of the Diabetes Anxiety and Depression Scale in type 2 diabetes mellitus: the phase II diabetes study of Fremantle. PLoS One. 2018;13(3):e0194417. doi:10.1371/journal.pone.0194417

21. Draznin B, Aroda VR, et al; American Diabetes Association Professional Practice Committee. 14. Children and adolescents: standards for the medical management of diabetes-2022. Diabetic treatments.2022;45(suppl1):S208-S231. doi:10.2337/dc22-S014


Comments are closed.