Psychological Burden of Diabetes and What It Means to People with Diabetes



Diabetes mellitus is a complex metabolic disorder characterized by persistent hyperglycemia (higher than normal blood glucose levels) resulting from defects in insulin secretion, insulin action, or both. It is one of the commonest long-term conditions and represents a major public health burden both in the UK and globally; it is estimated to affect approximately 3.1 million people in the UK alone and approximately 285 million people worldwide [1]. By 2030, it is projected that this figure will rise to more than 435 million as a result of changing population demographics, such as aging and urbanization, changes in lifestyle, such as diet and exercise, and the associated increase in obesity. Figure 1.1 below provides prevalence figures by country.


Comorbid Depression Psychological Burden Normal Blood Glucose Level Step Care Approach Special Care Baby Unit 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    International Diabetes Federation Diabetes Atlas 2009: website: (2009). Accessed 1 Sept 2011.
  2. 2.
    Barnard K, Lloyd CE. Experiencing depression and diabetes. In: Lloyd CE, Heller TD, editors. Long term conditions; challenges in health and social care. London: Sage Publications; 2011. ISBN 978-0-85702-749-8, 978-0-85702-750-4 (pbk).Google Scholar
  3. 3.
    Bowes S, Lowes L, Warner J, Gregory JW. Chronic sorrow in parents of children with type 1 diabetes. J Adv Nurs. 2009;65((5)):992–1000. doi:10.1111/j.1365-2648.2009.04963.x.PubMedCrossRefGoogle Scholar
  4. 4.
    Patterson CC, Dahlquist GG, Gyurus E, Green A, Soltesz G. Incidence trends for childhood type 1 diabetes in Europe during 1989–2003 and predicted new cases 2005–20: a multicentre prospective registration study. Lancet. 2009;373:2027–33.PubMedCrossRefGoogle Scholar
  5. 5.
    American Diabetes Association. Diagnosis and classifications of diabetes. Diabetes Care. 2010;33(1):S62–9.CrossRefGoogle Scholar
  6. 6.
    World Health Organisation: Definition, diagnosis and classification of diabetes mellitus and its complications: report of a WHO Consultation, Geneva. WHO/NCD/NCS/99.2; 1999.Google Scholar
  7. 7.
    Graham DJ, Ouellet-Hellstrom R, MaCurdy TE, Ali F, Sholley C, Worrall C, Kelman JA. Risk of acute myocardial infarction, stroke, heart failure, and death in elderly medicare patients treated with rosiglitazone or pioglitazone. JAMA. 2010;304(4):411–8.PubMedCrossRefGoogle Scholar
  8. 8.
    Rubin R. Diabetes and quality of life. Diabetes Spectr. 2000;3:21.Google Scholar
  9. 9.
    Barnard KD, Speight J, Skinner TC. Quality of life and impact of continuous subcutaneous insulin infusion for children and their parents. Practical Diabetes International. 2008;25:278–283.Google Scholar
  10. 10.
    Department of Health, National service framework for diabetes: standards, crown copyright 2001. (2001).
  11. 11.
    Sobieraj M, Williams J, Ryan P. The impact of depression on the physical health of family members. Br J Gen Pract. 1998;48(435):1653–5.PubMedGoogle Scholar
  12. 12.
    The Social Issues Research Centre ‘Social and cultural aspects of drinking: a report to the Amsterdam Group’. University of Edinburgh, Edinburgh.
  13. 13.
    Glasgow AM, Tynan D, Schwartz R, Hicks JM, Turek J, Driscol C, O’Donnell RM, Getson PR. Alcohol and drug use in teenagers with diabetes mellitus. J Adolesc Health. 1991;12(1):11–4.PubMedCrossRefGoogle Scholar
  14. 14.
    Ramchandani N, Cantey-Kiser JM, Alter CA, Brink SJ, Yeager SD, Tamborlane WV, Chipkin SR. Self-reported factors that affect glycemic control in college students with type 1 diabetes. Diabetes Educ. 2000;26:656–66.PubMedCrossRefGoogle Scholar
  15. 15.
    Lee P, Greenfield JR, Campbell LV. Managing young people with Type 1 diabetes in a ‘rave’ new world: metabolic complications of substance abuse in Type 1 diabetes. Diabet Med. 2009;26(4):328–33.PubMedCrossRefGoogle Scholar
  16. 16.
    World Health Organisation: Mental health: depression 2010. Website: (2010).
  17. 17.
    Ionnidis J. Effectiveness of antidepressants: an evidence myth constructed from a thousand randomised trials? Philos Ethics Humanit Med. 2008;3:14.CrossRefGoogle Scholar
  18. 18.
    Fournier J, et al. Antidepressant drug effects and depression severity. JAMA. 2010;303:47–53.PubMedCrossRefGoogle Scholar
  19. 19.
    Anderson RJ, Freedland KE, Klaus RE, Lustman PJ. The prevalence of comorbid depression in adults with diabetes: a meta-analysis. Diabetes Care. 2001;24(6):1069–78.PubMedCrossRefGoogle Scholar
  20. 20.
    Barnard KD, Skinner TC, Peveler R. The prevalence of comorbid depression in adults with Type 1 diabetes. Diabet Med. 2006;23(4):445–8.PubMedCrossRefGoogle Scholar
  21. 21.
    Gendelman N, Snell-Bergeon JK, McFann K, Kinney G, Wadwa RP, Bishop F, Rewers M, Maahs DM. Prevalence and correlates of depression in individuals with and without type 1 diabetes. Diabetes Care. 2009;32(4):575–9.PubMedCrossRefGoogle Scholar
  22. 22.
    Lloyd CE, Hermanns N, Nouwen A, Pouwer F, Underwood L, Winkley K. The epidemiology of depression and diabetes. In: Katon W, Maj M, Sartorius N, editors. Depression and diabetes. Oxford: Wiley-Blackwell; 2010.Google Scholar
  23. 23.
    Pouwer F, Geelhoed-Duijveestihn HLM, Tack CJ, Bazelmans E, Beekman A-J, Heine RJ, Snoek FJ. Prevalence of comorbid depression is high in out-patients with Type 1 or Type 2 diabetes mellitus. Results from the three out-patient clinics in the Netherlands. Diabet Med. 2010;27:217–24.PubMedCrossRefGoogle Scholar
  24. 24.
    Nouwen A, Winkley K, Twisk J, Lloyd CE, Peyrot M, Ismail K, Pouwer F, for the European Depression in Diabetes (EDID) Research Consortium. Type 2 diabetes mellitus as a risk factor for the onset of depression: a systematic review and meta-analysis. Diabetologia. 2010;53(12):2480–6.PubMedCrossRefGoogle Scholar
  25. 25.
    Holt RIG, Phillips W, Jameson KA, Cooper C, Dennison EM, Peveler RC. The Hertfordshire Cohort Study Group. Education and psychological aspects: the relationship between depression and diabetes mellitus: findings from the Hertfordshire Cohort Study. Diabet Med. 2009;26:641–8.PubMedCrossRefGoogle Scholar
  26. 26.
    Pouwer F, Beekman TF, Nijpels G, Dekker JM, Snoek PJ, Kostense RJ, Heine DJ, Deeg DJH. Rates and risks for comorbid depression in patients with Type 2 diabetes mellitus: results from a community-based study. Diabetologia. 2003;46:892–8.PubMedCrossRefGoogle Scholar
  27. 27.
    Lustman PJ, Anderson RJ, Freedland KE, de Groot M, Carney RM, Clouse RE. Depression and poor glycemic control: a meta-analytic review of the literature. Diabetes Care. 2000;23(7):934–42.PubMedCrossRefGoogle Scholar
  28. 28.
    Kovacs M, Obrosky DS. Major depressive disorder in youths with IDDM. A controlled prospective study of course and outcome. Diabetes Care. 1997;20(1):45–51.PubMedCrossRefGoogle Scholar
  29. 29.
    Katon WJ, Rutter C, Simon G, Lin E, Ludman E, Ciechanowski P, Kinder L, Young B, von Korff M. The association of comorbid depression with mortality in patients with type 2 diabetes. Diabetes Care. 2005;28(11):2668–72.PubMedCrossRefGoogle Scholar
  30. 30.
    Schram MT, Baan CA, Pouwer F. Depression and quality of life in patients with diabetes: a systematic review from the European depression in diabetes (EDID) research consortium. Curr Diabetes Rev. 2009;5(2):112–9.PubMedCrossRefGoogle Scholar
  31. 31.
    Gary TL, Crum RM, Cooper-Patrick L, Ford D, Brancati FL. Depressive symptoms and metabolic control in African-Americans with type 2 diabetes. Diabetes Care. 2000;23(1):23–9.PubMedCrossRefGoogle Scholar
  32. 32.
    Hermanns N, Kulzer B, Krichbaum M, et al. Diabet Med. 2005;22(3):293–300.PubMedCrossRefGoogle Scholar
  33. 33.
    Pouwer F, Hermanns N. Insulin therapy and quality of life. A review. Diabetes Metab Res Rev. 2009;25 Suppl 1:S4–10.PubMedCrossRefGoogle Scholar
  34. 34.
    Polonsky W, Anderson B, Lohrer P, Welch G, Jacobson A, Aponte J. Assessment of diabetes related distress. Diabetes Care. 1995;18:754–60.PubMedCrossRefGoogle Scholar
  35. 35.
    Department of Health: Turning the corner improving diabetes care. 2006. (2006).
  36. 36.
    NHS Confederation. Key statistics on the NHS. London: NHS Confederation; 2007.Google Scholar
  37. 37.
    Gunnell D, Ashby D. Antidepressants and suicide: what is the balance of benefit and risk? Br Med J. 2004;329:34–8.CrossRefGoogle Scholar
  38. 38.
    Hollinghurst S, Kesseler D, Peters TJ, Gunnell D. Opportunity cost of antidepressant prescribing in England: analysis of routine data. Br Med J. 2005;330:999. doi:10.1136/bmj.38377.715799.F7 accessed 15.10.2010.CrossRefGoogle Scholar
  39. 39.
    Rosenthal GE, Shah A, et al. Variations in standardized hospital mortality rates for six common medical diagnoses: implications for profiling hospital quality. Med Care. 1998;36(7):955–64.PubMedCrossRefGoogle Scholar
  40. 40.
    Ciechanowski PS, Katon WJ, Russo JE. Depression and diabetes: impact of depressive symptoms on adherence, function, and costs. Arch Intern Med. 2000;160(21):3278–85.PubMedCrossRefGoogle Scholar
  41. 41.
    NDST: National diabetes support team fact sheet: no 10: working together to reduce length of stay for people with diabetes. (2005).
  42. 42.
    NICE: Depression in adults with a chronic physical health problem. (2009). Accessed 15 Oct 2010.
  43. 43.
    Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 2007;67(6):361–70. doi:10.1111/j.1600-0447.1983.tb09716.CrossRefGoogle Scholar
  44. 44.
    Peyrot M, Rubin RR. Diabetes Care. 1997;20(4):585–90.PubMedCrossRefGoogle Scholar
  45. 45.
    Hermanns N, Kulzer B, Krichbaum M, Kubiak T, Haak T. How to screen for depression and emotional problems in patients with diabetes: comparison of screening characteristics of depression questionnaires, measurement of diabetes-specific emotional problems and standard clinical assessment. Diabetologia. 2006;49(3):469–77.PubMedCrossRefGoogle Scholar
  46. 46.
    National Screening Committee: The UK’s National Screening Committee’s criteria for appraising the viability, effectiveness and appropriateness of a screening programme. Available at: (2007).
  47. 47.
    Hermanns N, Kulzer B. Diabetes and depression – a burdensome co-morbidity. Eur Endocrinol. 2008;4(2):19–22.Google Scholar
  48. 48.
    ADA. Standards of medical care in diabetes – 2007. Diabetes Care. 2007;30 Suppl 1:S4–41.Google Scholar
  49. 49.
    IDF Clinical Guidelines Task Force. Global guidelines for type 2 diabetes. Brussels: International Diabetes Federation; 2005.Google Scholar
  50. 50.
    Canadian Diabetes Association Clinical Practice Guidelines Expert Committee. Canadian Diabetes Association 2003 clinical practice guidelines for the prevention and management of diabetes in Canada. Can J Diab. 2003;27 Suppl 2:1–152.Google Scholar

Copyright information

© Springer-Verlag London Limited 2012

Authors and Affiliations

  1. 1.Faculty of MedicineUniversity of SouthamptonChilworth, SouthamptonUK
  2. 2.Faculty of Health & Social CareThe Open UniversityMilton KeynesUK
  3. 3.Human Development and Heath Academic Unit, Faculty of MedicineUniversity of Southampton, Southampton General HospitalSouthamptonUK

Personalised recommendations