October 2023 • PharmaTimes Magazine • 30-31
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The importance of mental well-being across diabetes therapy
There are over half a billion people living with diabetes globally with the number continuously on the rise – and it is a condition that never takes a break.
Living with diabetes comes with not only a physical set of responsibilities to manage, but also with lesser-recognised psychological burdens.
Whether someone is well into the diabetes journey or only recently diagnosed and just coming to terms with how much impact it can have on everyday life, the demands of daily diabetes management can profoundly affect someone’s mental health and overall quality of life.
While blood glucose monitoring and often insulin dosing is crucial, there are countless other things to consider for people with diabetes to stay in their therapeutic target range – or simply just live their life.
Being physically active, planning meals, going to sleep, having a night out or travel are just a handful of things that require additional consideration or preparation. People with diabetes on insulin therapy have to make more than 180 therapy decisions each day.
This can easily become overwhelming and lead to diabetes distress – from which almost a third of the people living with diabetes around the world suffer.
This World Mental Health Day on 10 October and World Diabetes Day on 14 November, Roche Diabetes Care is highlighting the unmet mental health needs for people with diabetes, and why mental well-being must be addressed as an urgent health priority.
We want to ensure mental health issues are recognised as significant diabetes-related complications, and that preventing and managing these issues are crucial in pre-empting the knock-on effect they can have on individuals and their care.
Burnout
Feeling frustrated, defeated or overwhelmed by the experience of living with diabetes is known as diabetes distress, which can further spiral into depression and anxiety. Diabetes burnout is more extreme still, characterised by feelings of hopelessness, detachment and powerlessness.
‘Mental health conditions are common and often resolvable issues, but people need to be empowered and encouraged to seek help’
These challenges can develop with any diabetes type: around 40% of people with type 1 diabetes report diabetes distress, and one study reported that 36% of people with type 2 diabetes experience diabetes burnout.
Diabetes distress and burnout can exacerbate the daily challenges of managing the condition, making it very difficult to sustain good habits in terms of diet, exercise and adherence to therapy regimens.
Feeling stressed can make overall diabetes management even more difficult as the stress hormones that are released can limit insulin efficacy, resulting in high blood glucose levels.
Diabetes distress has further implications and knock-on effects, as it can actually lead to disengagement with the treating physician or the diabetes nurse educator and overall therapy.
If these struggles are not addressed, the resulting therapeutic inertia can cause issues with glycaemic control, which can eventually lead to secondary complications such as micro- and macrovascular complications, cardiovascular disease, blindness, amputations, cognitive decline and premature death.
Barriers
Fear of discrimination about having diabetes can also lead people to forego their insulin injections or blood glucose measurements when out in public. A lack of understanding in the workplace leads to people with diabetes experiencing discrimination and difficulties with self-management due to limited flexibility to eat, take medications or attend appointments.
Increasing awareness among the general public can also help reduce stigma and improve mental and physical health outcomes for people living with diabetes.
There is an urgent need to eradicate stigma related to diabetes and let people know that it is ‘Okay to not be OK’. Mental health conditions are common and often resolvable issues, but people need to be empowered and encouraged to seek help.
Evolution
Fortunately, it is often possible to prevent diabetes-related mental health complications from going too far and causing long-term or irreversible complications.
For people with diabetes who are facing an overwhelming list of steps to manage their condition and steer their therapy, there is more that can be done to ensure that their mental health needs are being met.
Consequently, Roche Diabetes Care is advocating to take collective action by playing a role in supporting a personalised and holistic approach to diabetes care. We also want to increase the awareness of how important mental health assessments are for everyone living with diabetes as part of the routine doctor visits.
We should consider how we can provide the best education and support for people with diabetes, and the right resources for their wider support network, such as loved ones, diabetes educators and healthcare professionals.
The right support can help to empower people to prioritise mental well-being as a vital part of the diabetes management journey.
We need to use all the tools available – medicinal, therapeutic and technological – to treat people with diabetes and mental health issues associated with the condition. For example, for individuals with diabetes, there are notable mental health benefits of using connected technology to track blood glucose levels.
Recent studies have demonstrated that self-monitoring of blood glucose using a blood glucose meter connected to a mobile app can significantly improve diabetes self-management and reduce HbA1C levels over a 120-day period as well as significantly reduce the level of distress in participating people with diabetes (T1D, T2D, gestational).
Early intervention to improve access to mental health support promotes long-term prevention and can also significantly reduce the burden on healthcare systems by lowering the number of hospital admissions and interventions for secondary health complications.
It is therefore essential that people with diabetes can recognise signs and symptoms of diabetes distress and burnout early.
Solution
We need to connect what counts in diabetes and mental well-being and encourage conversations about the stigma and mental health challenges faced by people living with this chronic condition.
Everybody can help to normalise conversations about mental health, as we all have a responsibility to be allies and contribute to creating a safe space at home, work, school or in the wider community.
We can all raise awareness and improve understanding of the condition and its often-invisible complications. Ensuring that people with diabetes are supported in the ways that they need can help prevent both physical and mental well-being from deteriorating.
Julien Boisdron is Chief Medical Officer at Roche Diabetes Care.
Go to roche.co.uk
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