Diabetes Distress: How Diabetes and Mental Health Go Hand-in-Hand

A diabetes diagnosis increases the risk of a mental health condition like general anxiety or major depression, and diabetes distress. Defined as feeling burdened or defeated from having diabetes, people with diabetes distress tend to have higher blood glucose and more diabetes-related complications. Both mental health issues and diabetes distress interfere with quality of life. I recently talked with expert, Dr. Julie Wagner, about depression, distress, and quality of life in people with diabetes.

Who is Dr. Julie Wagner?

Diagnosed with type 1 diabetes at age 2, Dr. Julie Wagner is Professor of Behavioral Sciences and Community Health at the University of Connecticut Health Center and a licensed clinical health psychologist. With funding from the NIH, American Diabetes Association, and American Heart Association, she studies how psychological experiences and exposures affect risk for diabetes and its complications. In the October 2016 “Diabetes and Psychology” Special issue of American Psychologist, Drs. Julie Wagner, Mary de Groot, and Sherita Hill Golden authored the article Psychological Conditions in Adults with Diabetes. With a bio like that, Dr. Wagner is the perfect person to discuss just how diabetes and mental health really do go hand-in-hand. Below, Dr. Wagner breaks down some basics for us.

How do we prevent diabetes distress?

Diabetes distress comes from the day-to-day burden of managing diabetes. We don't know how to prevent it, but we know what it's related to — long-term complications, being on insulin for people with type 2 diabetes. Once we know who's vulnerable to diabetes distress, we can target and tailor solutions to different groups.

What’s the best way to treat diabetes distress?

Confidence combats diabetes distress. Improving people's self-efficacy — helping them be more confident about their ability to manage their diabetes – may reduce diabetes distress. It also helps to know that difficulty meeting treatment goals is a normal part of living with diabetes for most people. A coaching expert can increase people's confidence and self-efficacy and can help normalize the struggle of living with diabetes.   Common reasons for diabetes distress are not meeting treatment goals, not knowing what to do in certain eating situations, and a constant worry about complications. Access to a support team can help with each of these reasons.

What’s the best way to stay on track when life gets in the way of managing diabetes?

Chronic stressors, major life events, and daily hassles affect everyone. For people with diabetes, they may contribute to diabetes distress, co-morbid depression, and quality of life. When this happens, people need someone who listens well and provides non-judgmental support. Encouragement, motivation, and even a little humor and commiseration are helpful. For dealing with everyday stressors, diabetes-specific knowledge or expertise is less important. Social and emotional support without the diabetes specific-ness may be sufficient.

The One Drop | Mobile app offers anonymous data sharing, allowing people to learn from and support each other. How helpful is this?

There's probably a good number of people who find this helpful. They may feel less isolated, less stigmatized, and feel a sense of social connection. Some people find it quite helpful to receive positive regard for certain health behaviors such as acknowledging that they got through the night without eating or that they reached their walking goals for the day. Many of us need a little cheerleading!

You're knowledgeable about diabetes and co-morbid depression. Our One Drop Heath Experts are certified diabetes educators, but not necessarily clinical psychologists. How might they still be a part of the solution?

Behavioral theories say that depression is caused and maintained because the person lacks positive interactions with their environment such as the family and workplace. Anything that introduces and reinforces positive events and activities can reduce depressive symptoms. 24/7 support from a coaching expert may introduce and reinforce such positive interactions in many people's lives.   A program like One Drop | Experts can also help people improve problem-solving skills and communication skills. Both are important for reducing depressive symptoms.   Experts can also provide another set of eyes and ears to recommend that people seek professional mental health treatment if it becomes necessary.

You've studied low-income minorities with diabetes. How is One Drop poised to help vulnerable populations with the condition?

One Drop may not be for everyone, but there might be a sizable amount of people who will benefit from it. I'd love to see it be an equalizer. People with diabetes may live in rural areas, be disabled, lack transportation to get to the doctor’s office, etc. If One Drop's | Premium subscription service successfully makes it easier to access care, it could be a game changer.

Anything else?

It's difficult to live with and manage diabetes. Addressing the emotional side of diabetes, especially diabetes distress, is important. My opinion is that it's as important as achieving glycemic targets.
There's always plenty more room for discussion in the diabetes and mental health realm. For more reading material, read up on our Expert, Dr. Mark Heyman's definition of diabetes and mental health, and how much further is needed to go in promoting awareness for diabetes distress.
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Chandra Y. Osborn, PhD, MPH
Dec 11, 2016

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