The link between diabetes and depression was highlighted by specialist psychiatrist Wisani Makhomisane at a recent medical conference in Cape Town.
Makhomisane said a quarter of all adults with diabetes have symptoms of depression, and those with pre-existing depression have a 60% greater risk of developing type 2 diabetes. Both diseases are silent and hidden, and are carried by highly functional people, she told the Cardiometabolic Axis Forum conference. She has a special interest in maternal, child and adolescent mental health and addiction.
South Africa has had the quickest rise of diabetes on the continent, from an estimated 1.9-million cases in 2011 to 4.2-million by 2021, and 7.5-million people are predicted to be afflicted by 2045. About 20% of the South African adult population is either diabetic or pre-diabetic.
Makhomisane described both diabetes and depression as “functional cognitive impairment”.
She was part of a multidisciplinary group of specialist physicians, counsellors and education activists at the conference who pooled the latest information on South Africa’s diabetes pandemic.
The conference brought together endocrinologists, psychiatrists, cardiologists, nephrologists and practitioners of other disciplines to apply the best minds to the diabetes pandemic, sharing the latest research, data and strategies. Sessions were held about education, living with diabetes, special populations, advanced therapies, cardiometabolic diseases, and technology and ethics.
The meeting came amid a burgeoning diabetes pandemic driven by unhealthy lifestyles and dietary choices, most often in fast-transitioning, modernising developing countries.
Makhomisane urged “relinking emotions to physical health” and providing psychosocial support for diabetics. She said diabetic burnout is a reality for 33%-50% of people with diabetes.
“We try hard to manage it, but we’re not seeing the results,” she said of the disease. “Patients develop a health problem related to diabetes despite our best efforts. They feel emotionally exhausted, stop taking treatment and avoid their doctor’s appointments.”
One in 10 South Africans have been diagnosed with diabetes and one in four with clinical depression, while one in four adults with diabetes have some symptom of depression. Pre-existing depression increases the risk of developing type 2 diabetes by up to 60%, Makhomisane said. Uncontrolled diabetes carries a high risk of heart attack and stroke, kidney problems, nerve damage, serious foot problems, gum disease and cancer.
We try hard to manage [diabetes], but we’re not seeing the results
— Wisani Makhomisane
Makhomisane said depression hides “inside the lives of functional people”, while diabetes is asymptomatic early on, also making it silent. She described depression as “one of the most debilitating conditions, as it is present with cognitive impairments that negatively influence prognosis of many physical conditions”.
Makhomisane said she did “a double take” when seeing research suggesting that depression is linked to a four-times-higher early death risk in diabetics. “I said to myself: ‘It scares me if we’ve indeed found causality’.”
She defined clinical depression as a persistent depressive disorder, in other words, a depressed mood for two years or more with changes in appetite, insomnia, nonrestorative sleep, poor concentration, indecision, hopelessness and low self-esteem.
Makhomisane urged all physicians, but especially endocrinologists (among whose specialities is diabetes), to refer patients to a mental health counsellor. “Get them some one-on-one time with a diabetes educator ... so that they can problem-solve together. Focus on one or two small diabetes management goals instead of working on everything at once. [Advise patients to] join a diabetes support group and share thoughts and feelings with others who have the same concerns.”
She said: “People with diabetes are two to three times more likely to have depression than those without it. Only 25%-50% of people with diabetes who have depression get diagnosed and treated. However, treatment — therapy, medicine, or both — is usually very effective. Without treatment depression often gets worse.”
Makhomisane said that when people are under acute stress, “their brain switches off. You can psycho-educate all you want, but I doubt they’ll be able to hear you. It’s a chronic stress response and caused chemically in the body.”
She said noncommunicable diseases such as diabetes and depression are interlinked. The solution is integrated, patient-centred care. She urged doctors to screen all patients, but especially diabetics, for depression when examining their histories.
“Depression might have preceded diabetes. Use screening tools to classify the severity, and psycho-educate patients about the symptoms of both depression and diabetes.
“Psychiatrists should also screen for diabetes,” she said.
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