As recently reported by Fox News and other media outlets, depression is a common effect of type 1 diabetes (T1D). In fact, people with type 1 diabetes may be up to four times more likely than the general population to develop depression1.
Due to these startling statistics, GluAnna and GluDanielle have teamed up to examine Depressed Mood is a Factor in Glycemic Control in Type 1 Diabetes”2, by Van Tilburg et. al., a research article published in 2001. In response to the article, we present both the patient perspective and the analytical research angle.
Depression is different than diabetes-related burn out or daily mood fluctuations. Major depression (also known as clinical depression) is a serious disorder. The two most common reported symptoms include decreased interest or pleasure in one’s normal activities, as well as depressed mood. In order for an official clinical diagnosis of depression to be made, one must exhibit five out of eight symptoms indicated in the over the previous two weeks.
Why we chose this article
While this article is slightly dated, it is a great foundational article in a few ways. First, it makes the point that differentiating type 1 and type 2 diabetes is important in determining how depression is related to either disease. This was one of the first articles to address the idea that combing type 1 and type 2 in psychological research creates confusing results and misinforms the public. We also appreciated the authors’ clear writing and straightforward results, and felt it was a good fit for the Glu community.
Study Methods and Results
The researchers in this study recruited 64 people with diabetes (about half were type 1) and collected information from them, including HbA1c, how often people self-monitor their own blood glucose, and demographic variables. They also assessed depressive symptoms by using a scale called the Beck Depression Inventory. This is a 21-question multiple choice measure3 that asks pretty straightforward questions regarding specific feelings. For example, one item is:
- I don’t feel disappointed in myself
- I am disappointed in myself
- I am disgusted with myself
- I hate myself
This scale is widely used by healthcare professionals to get a rough idea of whether or not someone is experiencing mild mood disturbances, borderline depression, clinical depression, or severe depression.
In this study, the researchers found that the majority of the participants scored below the cutoff for clinical depression, but many did show depressive symptoms.
There was no difference in depression scores between those with type 1 and those with type 2 diabetes; that is, both groups showed the same amount of depressive symptoms. However, they found a strong relationship between HbA1c and depressive symptoms in those with type 1 diabetes, but not those with type 2 diabetes. This was a positive correlation; that is, higher depressive scores were related with higher HbA1c levels.
This study is important, because it shows that even subclinical depression has a relationship with blood glucose control. That is, you don’t have to be incredibly depressed to see an effect on health. Low levels of depressed mood do seem to have a profound impact.
Why is this difference only seen in those with type 1? I suggest that mood has a greater impact on health-related behavior in those with type 1. Because type 1 diabetes relies so heavily on day-to-day (heck, hour-to-hour) self-care, it may be that those who are more depressed than others are struggling to manage their disease. Indeed, the study also reports that those who check their blood sugar less often are also more depressed. Alternatively, it could be that feeling sad causes stress, and this stress increases daily blood glucose levels. But then, we would expect to see the same results in those with type 2. This article really drives home the importance of taking care of yourself, both mentally and physically, and points to a strong mind-body connection.
After reading the article as well as listening to years of lectures and poster sessions and patient testimonials, there is clearly a correlation between depression and diabetes self-management. This seems so obvious to me! It just makes sense.
But which causes which? Is it the depression leading to lack of motivation in managing the diabetes, or are the high blood sugars and overwhelming thoughts and fears and tasks triggering the depressed mood? More and more research needs to be done to tackle this issue. Day in and day out, I feel it is indescribably challenging and frustrating for my brain to not only function as a brain, but a pancreas as well. It’s a nearly impossible task.
As we,, people with type 1, caregivers, and providers continue to dig deeper and attempt to understand what drives our depression, let’s remember this difficult fact.
If you’d like to assess your or your child’s depressive symptoms, you can take the Beck Depression Inventory here.
- Barnard, K. D., Skinner, T. C., & Peveler, R. (2006). The prevalence of co‐morbid depression in adults with Type 1 diabetes: systematic literature review.Diabetic Medicine,23(4), 445-448.
- Van Tilburg, M. A., McCaskill, C. C., Lane, J. D., Edwards, C. L., Bethel, A., Feinglos, M. N., & Surwit, R. S. (2001). Depressed mood is a factor in glycemic control in type 1 diabetes.Psychosomatic medicine,63(4), 551-555.
- Beck, A. T., Steer, R. A., & Brown, G. (1987). Beck Depression Inventory Manual. San Antonio, TX: The Psychological Corporation.Harcourt Brace Jovanovich. Beck, AT, Ward, CH, Mendelson, M., Mock, J., & Erbaugh, J.(1961). An inventory for measuring depression. Archives of General Psychiatry,4, 561-571.