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Should we screen for emotional distress in type 2 diabetes mellitus?

Abstract

Emotional problems such as depression, anxiety and diabetes-specific distress are common in patients with type 2 diabetes mellitus (T2DM) but often remain unrecognized and thus untreated. The present Review focuses on the extent of this problem and discusses whether we should screen for depression, anxiety and diabetes-specific distress in patients with this condition. Depression has received by far the greatest attention from researchers. Strong evidence exists that depression affects 10–20% of patients with T2DM, but it is often unrecognized. Several guidelines have therefore recommended periodic assessments of emotional well-being in patients with T2DM. However, this recommendation is not based on strong evidence, as the effects of screening (case-finding) on psychological outcomes and diabetes outcomes have not been tested in a randomized controlled study. Results from studies in patients without T2DM have shown that screening for depression does not improve outcomes. On the other hand, collaborative care approaches for depression in patients with type 1 diabetes mellitus (T1DM) or T2DM seem to be effective. Intervention studies for anxiety or diabetes-specific emotional distress are currently lacking, and further research that can help to optimize antidepressant treatment is also urgently needed.

Key Points

  • Depression is a common complication of T2DM, and affects at least 10–20% of patients

  • Anxiety and diabetes-specific distress (for example, worries about complications, concerns about food, fear of hypoglycemic episodes, diabetes burn-out) are also common comorbid problems in T2DM

  • The mechanisms behind the association between emotional problems and T2DM are complex and probably relate to impaired self-care behaviors and biological processes

  • Depression in T2DM can be treated with cognitive behavioral therapy and antidepressant medication; however, the effectiveness of antidepressant medication seems to be overestimated

  • Detection of depression, anxiety and high levels of diabetes-specific distress by physicians and nurses is generally lower than 50%

  • Use of self-report questionnaires can help to increase detection rates, but it seems crucial that screening procedures are embedded in a stepped care approach

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Acknowledgements

D. Lie, University of California, Irvine, CA, is the author of and is solely responsible for the content of the learning objectives, questions and answers of the MedscapeCME-accredited continuing medical education activity associated with this article.

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Correspondence to François Pouwer.

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Pouwer, F. Should we screen for emotional distress in type 2 diabetes mellitus?. Nat Rev Endocrinol 5, 665–671 (2009). https://doi.org/10.1038/nrendo.2009.214

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