Diabetes and Mental Health

•The diagnosis and management of diabetes can be a significant life stressor for individuals and their families, and may be associated with challenges regarding illness acceptance and treatment participation. Addressing concerns regarding illness beliefs and participation in treatment recommendations can be helpful.•The lived experience of diabetes is often associated with struggles specific to the illness and can lead to significant concerns, specifically diabetes distress, perpetuation of stigma, reluctance to initiate insulin when recommended, and the persistent fear of hypoglycemic episodes. •Well-established reactions to diabetes include: perceptions about the seriousness of the disease (either discounting the seriousness of diabetes, which is often seen in those with asymptomatic type 2 diabetes [T2D], or becoming overwhelmed by the diagnosis, often seen in individuals and families with type 1 diabetes [T1D]); not comprehending the extent to which diabetes can be managed; the degree of personal responsibility required for management; and the perceived benefits and barriers to taking action. Professional support to address these reactions can be helpful in promoting self-management of diabetes. •Weight-based stigma—the perception and experience of being discriminated against due to one’s body weight—can be perpetuated by providers in health-care settings. When present, this can lead to worsening distress, diminished quality of life, as well as decreased diabetes self-management behaviours. Health-care providers must be aware of their own biases and be able to communicate in a non-stigmatizing manner about weight-related issues and diabetes management. •Diabetes is an expensive illness to live with and to manage well. People living with diabetes should ask their health-care teams for help and health-care providers should recognize the key role they play in accessing financial supports. Advocacy and activism are helpful and often necessary to manage the cost of living with diabetes.•The costs associated with diabetes can have effects on the physical and emotional well-being of people with diabetes. •A wide range of psychiatric disorders (beyond the serious mental illnesses of major depressive disorder [MDD], bipolar and related disorders, and schizophrenia spectrum disorders) put people at higher risk for developing diabetes (usually T2D) compared to the general population.•People living with diabetes and MDD are at increased risk for earlier all-cause mortality compared to people living with diabetes without a history of MDD.•Compared to those with diabetes only, individuals with diabetes and mental health concerns are at risk for functional impairment, diabetes complications, and increased health-care costs, often coupled with decreased participation in diabetes self-care and decreased quality of life. •Individuals with diabetes in pregnancy are at an increased risk of developing mental health disorders (e.g. depressive and anxious symptoms) and psychological distress throughout the pregnancy. Receiving effective emotional and tangible support, in addition to medical advice, can help buffer these negative outcomes. •Youth with diabetes are at risk for having psychosocial symptoms and diabetes self-management difficulties. Regular assessments during routine diabetes care are especially helpful during adolescence and the transition to young adulthood.•It is important to also assess the emotional functioning of the whole family/home environment—including parent/caregiver distress and fear of hypoglycemia—in order to understand the potential impact of these influences on younger people with diabetes. •Depressive symptoms in older adults with T2D are an important risk factor for cognitive impairment and are associated with an increased risk of earlier mortality.•Older people with T2D experience an increased disease burden and are more likely to have multimorbidity (an increased likelihood of complications and other adverse outcomes). •Substance use is linked with multiplicative health risks and can be a factor in the development of new-onset T2D, as well as worsening health outcomes among those with established diabetes.•Smoking cigarettes and/or alcohol consumption are risk factors for the development of T2D and adverse cardiovascular events in people with established diabetes.•People prescribed insulin are more susceptible to the harmful effects of recreational substance consumption, particularly alcohol use.•Screening for substance use followed by a brief intervention can be helpful, and approved pharmacotherapies for tobacco, alcohol, and opioid use disorders are safe for use in people with diabetes. •People with diabetes are at higher risk for developing more severe complications from a COVID-19 infection. Preventative measures, such as keeping a safe distance from others, wearing a mask in public, regular handwashing, and keeping up to date on vaccinations, help reduce the risk of acquiring the virus and potentially the severity of the illness. •All individuals with diabetes, as well as the parents or caregivers of youth with diabetes, should be screened at appropriate intervals for the presence of diabetes distress, as well as symptoms of common psychiatric disorders.•People with diabetes are at risk for developing a wide array of mental health conditions—especially mood and anxiety disorders—and should be screened regularly for symptoms that may be part of a psychiatric condition. •Person-centred approaches using motivational interviewing, cognitive behaviour therapy (CBT), acceptance and commitment therapy, stress management, coping skills training, family therapy, and collaborative case management should be incorporated into primary care, wherever possible.•Building self-management skills, employing educational interventions that facilitate adaptation to diabetes, and addressing co-occurring mental health issues that reduce diabetes-related distress, fear of hypoglycemia, and reluctance to initiate insulin when recommended, are all helpful. •There are effective treatments for the disabling symptoms that comprise psychiatric conditions. Regular use of medication can be a crucial element in helping people maximize their function and reduce symptom severity. •Individuals taking psychiatric medications, particularly (but not limited to) atypical antipsychotics, benefit from regular screening of metabolic parameters to identify glucose dysregulation, dyslipidemia, and changes in weight (and possibly other anthropometric measures) throughout the course of the illness so that appropriate interventions can be instituted if necessary. •Living with diabetes can be burdensome and anxiety provoking. The constant demands of having to care for the illness take a psychological toll. As a result, many people struggle to accept the diagnosis or proposed treatment plan and delay actively participating in diabetes care, which only worsens the long-term outlook. •Diabetes is often associated with distress over the need for daily self-care, adding stress to relationships, a significant emotional burden. It is important to be compassionate with yourself and accept your emotions as valid responses to a chronic condition. In addition to self-care, seeking out support by talking to your friends, family, and members of your diabetes health-care team about how you are feeling can be helpful. Your team can help you to develop effective coping skills and direct you to mental health–care services that can make a difference for you. •Diabetes-related or weight-related stigma (feeling or experiencing social judgement) is common and can lead to a decreased sense of well-being, as well as making you feel less motivated to care for your diabetes. •Caring for diabetes effectively can be expensive, and can exceed the ability of many people to manage financially. There may be ways to reduce these costs. So, if your finances are suffering, let your health-care team know—it is possible that something helpful can be done. •Mood and anxiety symptoms are common in people with diabetes and can be impairing enough to lead to a formal psychiatric diagnosis. Eating, sleeping, and stress-related problems are also common. Speak to your health-care providers about the concerns that you have.•Mental health issues can affect your ability to cope with and care for diabetes. Caring for your mental health is just as important as caring for your physical health and improves the long-term picture for your diabetes.•People diagnosed with many psychiatric conditions appear to have a higher risk of developing diabetes than the general population. •If you have diabetes and are planning on becoming pregnant (or already are pregnant), your diabetes care team is available to offer psychosocial support and, if necessary, referrals to mental health resources. •Younger people often face psychological struggles that negatively impact managing diabetes. Share your physical and emotional struggles with your diabetes care team so they know what to help you with.•Diabetes care impacts the whole family, so it is important to also discuss parent/caregiver’s psychosocial functioning with the diabetes team. There are interventions that can improve everyone’s well-being. •Older individuals with T2D have more complications and adverse outcomes compared to younger individuals with T2D, which can make treatment more challenging and complicated. •Smoking causes greater health harms in people with diabetes compared to those who do not have the illness. Even 1 cigarette per day is harmful to your health. If you smoke, consider asking for support from your health-care provider to help you quit. Using a smoking cessation medication (nicotine patches, varenicline, or bupropion) together with counselling more than doubles your chances of quitting successfully.•If you currently do not drink alcohol, it is a healthier decision to not start. For people who drink alcohol, it is imperative to reduce intake to minimize adverse health outcomes. This may mean consuming a maximum of 2 standard drinks per week, which has been linked with causing the least potential for harm. Consuming over 4 standard drinks per occasion has the potential to negatively affect diabetes care. Ask your health-care provider for support if you wish to reduce your alcohol use.•Substance use with cannabis, stimulants, or illicit opioids may interfere with your blood glucose levels and your ability to manage your diabetes, particularly if these substances are consumed on a regular basis or in a large quantity over a short time (binges). •Diabetes puts people at greater risk of having complications if you get infected with COVID-19. Preventative measures, such as keeping a safe distance from others, regular handwashing, and wearing a mask in public places, reduce the chance of acquiring COVID-19. Keeping up with vaccinations may reduce the severity of the infection if you do get it. You must do your best to reduce your chances of developing long COVID. •Your health-care provider can offer screening questionnaires that you can complete to help better understand your experiences and aid in planning treatment for diabetes. There are questionnaires to screen for diabetes-related concerns, as well as for general psychological distress. Screening questionnaires can be completed prior to your appointment and the results discussed at your visit. •Diabetes care teams can help you manage the degree of distress that you are experiencing with strategies that are specific to living with diabetes. As well, they can arrange a referral to mental health services for concerns that may not be directly related to diabetes. •Medications, when taken regularly, can make a significant contribution to your health and ability to live your life with fewer troubling symptoms. If a medication has been recommended, consider giving it a good trial (taking it long enough as prescribed to determine if it is working) and then reporting the results to your clinician. Hopefully, you can find medications that make a positive impact on your health and are tolerable (few or no side effects). •Your mental health medications may need to be monitored for possible side effects. Monitoring your glucose levels, lipid levels, blood pressure, and changes in weight will give you peace of mind that your major health risks are being covered.