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More Guidance Needed on Mental Health Aspects of Diabetes
Boston, MA—Individuals with diabetes are more than twice as likely to face depression or varying degrees of mental health issues as individuals without the disease. Data from the World Health Organization (WHO) shows that mental health illness is the leading cause of disability-adjusted life years worldwide, accounting for 37% of healthy years lost; depression accounts for one-third of this disability. The WHO also found that the global cost of mental illness was nearly $2.5 trillion in 2010, with a projected increase to more than $6 trillion by 2030.
David G. Marrero, PhD, ADA president, Heath Care & Education, shared this information during his keynote address at the ADA Scientific Sessions conference. He focused on the future of diabetes care and research, and underscored the need for more research into the mental health aspects of diabetes.
“It is estimated that people with diabetes spend almost 9000 hours each year managing their diabetes on their own. This is very much a condition that we have to manage on our own.
It’s not easy, and it can really get to you,” said Dr Marrero, who has lived with type 1 diabetes for 40 years.
The ADA is working with the American Psychological Association to develop training programs for psychologists that focus specifically on the unique needs of individuals with diabetes, he noted.
“We need to increase the number of highly trained persons who can effectively address the mental health issues associated with adapting to and coping with diabetes,” said Dr Marrero, J.O. Ritchey Endowed professor of medicine and director of the Diabetes Translational Research Center, Indiana University School of Medicine.
The National Institutes of Health has looked at the stress of managing diabetes every day and the effects the disease has on the brain, which may contribute to depression. “Studies have shown that depression and diabetes may be linked, but scientists do not yet know whether depression increases the risk of diabetes or diabetes increases the risk of depression,” Dr Marrero said. “Current research suggests that both cases are possible.”
Therefore, he emphasized, more research is needed into the behavioral aspects of diabetes care to guide health care providers in addressing and supporting the emotional needs of their patients as part of routine care. “Despite the clear role behavioral factors and mental health play in diabetes treatment, they have not received the attention they deserve with regards to research and research funding,” he said.
Dr Marrero noted the dearth of grant submissions related to diabetes and mental health. Of the 5046 grants currently funded by the National Institute of Diabetes and Digestive and Kidney Diseases, 40 deal with mental health and behavioral issues, even fewer deal with behavioral aspects of diabetes, representing 0.8% of the total funding, he said.
The situation is similar at the National Institute of Mental Health, where only 35 of the institute’s 3648 grants have any mention of diabetes in their titles, accounting for only 0.9% of the total funding portfolio. To date, the ADA has received 571 grant submissions, and only 17 deal with behavioral and psychological issues, representing just 3% of total funding.
“We have to put the grants in. They don’t get approved if we don’t submit them,” said Dr Marrero. “I hear all the time from my colleagues, ‘We don’t see many of these things.’ That’s our fault. That is a fault we need to correct.”
He said diabetes advocates must make it clear to policymakers who control health care spending that diabetes patients need unfettered access to the quality care, medications, and management tools to effectively control their diabetes. Dr Marrero also announced that the ADA is preparing to launch a working group to help the FDA’s Patient-Focused Drug Development Initiative incorporate patient preferences and patient-reported outcomes in their review process for drugs and devices.
“It is finally time, brothers and sisters, that we consider how patients react to treatments beyond the clinical impact,” he said. “We need to hear their voices and how that figures into it.”—Eileen Koutnik-Fotopoulos
