Type 2 Diabetes and Depression - Updates from the ADA Symposium

Rachel Wilhelm, Pharm.D, Westside Community Health Services

Diabetes and depression are two of the most common conditions seen in ambulatory care, and many patients live with both diagnoses simultaneously. It is important to note that these two diseases do not occur in isolation of each other, but instead share a bidirectional relationship. Diabetes patients are twice as likely to have depression when compared to patients without diabetes. Conversely, the Multi-Ethnic Study of Atherosclerosis (MESA), sponsored by the National Institute of Health, found that patients living with depression have a 21 percent higher risk of developing diabetes.

The correlation between diabetes and depression may have biological origins. Abnormal patterns of cortisol and adrenaline in the hypothalamic pituitary adrenal axis have been associated with both disease states. Sherita Hill Golden, MD, of Johns Hopkins University School of Medicine, a researcher with the MESA, describes that this atypical stress hormone profile may explain the elevated diabetes risk in patients with depression. As we begin to better understand the mechanisms involved, new drug targets may emerge that allow for treatment of both conditions simultaneously.

Pharmacists play an important role in the management of patients with comorbid depression and diabetes. We can assist with management of medications, encourage healthy lifestyle modifications, provide education, and direct patients to appropriate resources. A variety of initiatives exist to combat diabetes, such as the National Diabetes Prevention Program. The CDC is working to ensure that this evidence-based lifestyle change program is available to people with prediabetes living anywhere in the nation. It is important that patients have access to coordinated comprehensive care that addresses both the physical and mental aspects of their health.

Reference:

1. American Diabetes Association. Expanded access to prevention programs and acknowledging increased risk of depression among people with diabetes can reduce complications and prevalence, and improve outcomes and quality of life. American Diabetes Association. http://www.diabetes.org/newsroom/ press-releases/2018/ expanded-access-to-prevention-programs-and-acknowledging-increased.html. Published June 25, 2018. Accessed July 24, 2018.