Diabetes patients are nearly three times as likely to suffer from depression than the general population.
The National Institute for Health and Disability Insurance has published an in-depth study on the association between diabetes and depression, based on the number of patients treated, in Belgium, for one and/or for another of these diseases. The statistical reference is to the consumption of reimbursed pharmaceuticals delivered in pharmacies in 2010. Data that may be used to teach others!
But first, let’s understand what diabetes exactly is!
What Is Diabetes?
Diabetes is a chronic disease that develops when the pancreas is unable to synthesize the amount of insulin that the human body requires, produces insulin of inferior quality, or is unable to use insulin effectively.
The pancreas produces insulin, a hormone that helps control blood sugar levels. Its primary role is to ensure that blood glucose levels remain within normal ranges. It allows glucose to enter the body and be carried into cells, where it is converted into energy that is used to power the functions of muscles and tissues. Furthermore, it aids in the storage of glucose in the cells until it is required for usage.
Because glucose is not distributed effectively in the body of people with diabetes, there is an excess of glucose in the blood (hyperglycemia).
The Context (Diabetes & Depression)
Type 1 diabetes (T1D, which emerges throughout childhood and adolescence), and type 2 diabetes (which manifests during adulthood) are the two major types of diabetes. Type 2 diabetes affects over 90% of all diabetics globally. T1D is treated with insulin, but T2D is handled with a mix of diet, exercise, oral diabetes medications, and if necessary insulin injections later in the disease.
To be clear, a significant proportion of diabetics are at risk of serious, even life-threatening, complications from diabetes, such as damage to the eyes, kidneys, and neurological system, as well as cardiovascular disease and limb injuries (the “diabetic foot”). It is vital to keep glycemia (glucose level of the blood) under strict control!
Diabetes Medications
For many years, oral diabetic medicines and insulin have been progressively increasing in Belgium, as they have in many other countries. The great majority of patients (76 percent) were only given oral diabetes medications. In total, around 560,000 patients are undergoing therapy (oral anti-diabetics, insulin, or a combination of the two).
As a result, a considerable number of people with type 2 diabetes have not yet been identified, and a non-negligible proportion of those who are aware of their condition do not follow suggested treatment regimens. Returning to the evolution of pharmaceutical sales, the annual rise between 2004 and 2010 was roughly 5% per year, a growth expressed in daily doses.
According to the National Institute for Health and Disability Insurance specialists, reimbursement expenses climbed by 7.5 percent each year during the same time, from 87 million euros in 2004 to 134 million euros in 2010. According to specialists, half of this money is allocated to insulin and analogues, which are much more expensive than oral anti-diabetics.
Diabetes & Depression
A lot of studies have shown that diabetic people have a substantially greater risk of depression than the overall population. By cross-referencing the National Institute for Health and Disability Insurance’s data, it was feasible to determine the number of diabetic patients who were treated with anti-depressants. The number of people in this situation appears to have reached 96,000 in 2010, implying that 17.2 percent of diabetic patients are also receiving therapy for depression.
Anti-depressants, on the other hand are taken by somewhat less than 7% (6.7%) of non-diabetic persons. As a result, the ratio is two to three, which is clearly pretty high.
Diabetic Patients At Risk!
Throughout the process of refining the data, new elements emerge. A variety of risk factors have been discovered in depressed diabetics, both general (and therefore not particular to diabetics) and specific (such as the development of diabetes-related problems, the existence of a chronic condition, being a woman, and so on); and specific (such as when diabetes is combined with another chronic disease or when diabetes is added to another chronic disease).
Two pieces of information should be highlighted in the National Institute for Health and Disability Insurance’s report. First and foremost, there is age. Diabetes and depression both have a linear increase in occurrence until the ages of 50-55, then a slight decrease until the ages of 65, and then begin to rise again. Looking at the curve that illustrates the evolution of depression cases in diabetics, we can observe that anti-depressant treatments are two to three times more prevalent in diabetes patients up to the age of 50, and that the ratio drops to one to two after that.
Second, there’s sex. Women with diabetes had nearly twice the likelihood of acquiring depression when compared to male individuals with diabetes: 23 percent vs 13 percent. If this difference exists in the general population, it affects far lower percentages of the whole population.
What Do The Experts Say?
Viviane de Laveleye, director of the BDA (Belgian Diabetes Association), was invited to talk on this topic at a European Association for the Study of Diabetes (EASD) meeting. “I’m not convinced diabetes distinguishes out in this sense when compared to other chronic conditions,” she said.
“What is apparent is that many people with diabetes will have to cope with an accumulation of difficulties that will impair entire sections of their everyday life over time.” As a result, it is not unexpected that some of them, possibly more vulnerable, are at risk of depression.
According to Viviane de Laveleye, “the healthcare teams have employees particularly educated in providing support.” Worry, changes in food habits, changes in marital relationships, changes in work life, treatment constraints…: type 2 diabetes has a large and possibly extremely disruptive influence on everyday life. As a result, it might make the bed of depression.